1: Combitube Insertion and Removal

Published on 06/03/2015 by admin

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Last modified 06/03/2015

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CombitubeCombitube Insertion and Removal

A Combitube may be used to provide an emergency airway during resuscitation of a profoundly unconscious patient who needs artificial ventilation when endotracheal intubation is not readily available or has failed in successfully establishing an airway.

PREREQUISITE NURSING KNOWLEDGE

• Anatomy and physiology of the upper airway should be understood.

• The Combitube does not require direct visualization of the airway for insertion and is inserted in a “blind” fashion, as an adjunct when endotracheal intubation attempts fail or trauma makes visualization of the airway difficult.1,8 The Combitube (Fig. 1-1) is available in two sizes, determined by patient height.¹²

Figure 1-1 Components of the Combitube.

The 37F size is used for patients 48 to 66 inches tall (122 to 168 cm).

Either size 37F or size 41F is applicable in patients 60 to 66 inches tall (152 to 168 cm).¹²

• For patients greater than or equal to 66 inches (168 cm), the 41F size should be used.

• The Combitube has a unique design that includes:

A double-lumen, semirigid airway

Blue lumen opening to the perforations between the cuffs

White lumen opening distal to the distal cuff

Each lumen fitted with a 15-mm male adapter

Two cuffs for occlusion

Proximal cuff (85 mL or 100 mL, depending on tube size) to occlude the hypopharynx

Distal cuff (12 mL or 15 mL, depending on tube size) to occlude either the esophagus or the trachea

Each cuff connected to a pilot balloon and valve: blue for proximal (No. 1), white for distal (No. 2)

Two black lines indicate the position of the patient’s teeth or gum line when the device is first inserted.

Because of the large inflated cuff in the hypopharynx, the Combitube needs no stabilization or securing after placement.

• The correct placement of a Combitube in the airway is as follows:

Esophageal insertion (Figs. 1-2 and 1-3), in which the distal cuff occludes the esophagus and the proximal balloon occludes the hypopharynx, allows ventilation via the blue lumen.

Figure 1-2 Esophageal insertion of a Combitube.

Figure 1-3 Combitube in esophageal position.

• Tracheal insertion (Fig. 1-4), in which the distal cuff occludes the trachea and the proximal balloon occludes the hypopharynx, allows ventilation through the white lumen.

Figure 1-4 Combitube in tracheal position.

• Before the insertion of a Combitube, adequate ventilation of an unconscious patient with a mouth-to-mask or a bag-valve-mask device is necessary.

• Use of the Combitube is contraindicated for airway management 8,12 in the following cases:

Patients with an intact gag reflex

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