Notice

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Notice
This presentation reviews the indications,
contraindications, precautions and insertion
techniques of the Kendall-Sheridan Combitube
brand esophageal tracheal airway device (ETA).
For other brand ETA devices, follow their
specific manufacturers instructions and
recommendationsCombitube is a registered
trademark of Kendall-Sheridan
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Overview

• Introduction The combitube, what is it?
• Indications
• Contraindication
• Precautions
• Equipment
• Insertion procedures

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What is a Combitube?

• A double lumen airway device designed for
  emergency ventilation of a patient in respiratory
  arrest when visualization of the airway and
  endotracheal intubation are not possible

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What is a Combitube?
It is designed to be inserted blindly. The double
lumen design allows effective ventilations to be
provided regardless of whether esophageal or
tracheal placement is accomplished
Distal balloon
Pharyngeal balloon
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What is a Combitube?

• The pharyngeal balloon fills the space between
  the tongue and soft palate, eliminating the need
  for a mask and the associated face mask seal
  problems.
• The patient can be successfully ventilated
  regardless if the tube is inserted into the
  trachea or the esophagus

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Indications
Respiratory failure in an unconscious patient
without an intact gag reflex Secondary method of
airway management for paramedics when orotracheal
intubation is not possible Primary method of
airway management for EMT-Bs (where allowed by
local protocols)
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Contraindications

• The patinet has in intact gag-reflex
• The patient is less than 5 feet tall or under 16
  years old
• The patient has known esophageal disease
• The patient has ingested a caustic substance
• Burns involving the airway
• The patient has an allergy or sensitivity to
  latex (the pharyngeal balloon contains latex)

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Precautions

• Take appropriate Body Substance Isolation (BSI)
  precautions including facial protection, as
  expulsion of stomach contents can occur through
  the 2 tube if the initial placement is in the
  esophagus.
• DO NOT force the tube. If it does not advance
  easily, redirect it or withdraw and reinsert
• Attach the fluid deflector elbow to the
  esophageal tube to deflect stomach contents away
  from rescuers

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Equipment
Full Body Substance Isolation (BSI). Face mask,
eye shield, protective eye-glasses, latex
examination gloves and hepa-mask if patient is
suspected of infectious disease
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Equipment
Esophageal Tracheal Airway (Combitube), 140ml
syringe, 20ml syringe, fluid deflector attachment
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Equipment
Suction device with FR suction catheter, BVM with
oxygen supply
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Insertion Procedures

• Place the patient in a supine position
• Provide artificial ventilation via BVM and
  hyperventilate the patient with 100 oxygen prior
  to device insertion

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Insertion Procedures

• Inflate both balloons prior to insertion to test
  the integrity of the balloons
• Should either balloon fail after insertion,
  maintenance of the patients airway cannot be
  assured

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Insertion Procedures

• Position the patients neck in a neutral position
  (the Combitube is designed to be blindly inserted
  into the esophagus)
• Lubricate the tube with sterile, water soluble
  lubricant
• Lift the tongue and lower jaw upward to open the
  oropharynx

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Insertion Procedures

• Insert the Combitube so that it curves in the
  same direction as the natural curvature of the
  pharynx
• If resistance is met, withdraw tube and attempt
  to reinsert

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Insertion Procedures

• Advance tube until the patients teeth are
  between the two black lines

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Insertion Procedures

• Inflate the 1 blue pilot cuff with 100ml of air
  from the large syringe

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Insertion Procedures

• Inflate the 2 white pilot cuff with 15ml of air
  from the small syringe

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Insertion Procedures

• Begin ventilation through the longer blue tube
  labeled 1. If auscultation of breath sounds is
  good and gastric inflation is negative, continue

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Insertion Procedures

• If auscultation of breath sounds is absent and
  gastric inflation is positive, then begin
  ventilation through the shorter clear tube
  labeled 2

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Esophageal Placement

• If the Combitube is placed in the esophagus, the
  distal balloon will occlude the esophagus.
• Ventilations are then provided through
  perforations in the side of the pharyngeal
  tube.Stomach contents can then be safely
  expelled via the hole in the end of the tube.

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Tracheal Placement

• If placed in the trachea, it functions as an
  endotracheal tube, with the distal balloon
  preventing aspiration.
• Ventilations are then provided via the hole in
  the end of the tube as in an endotracheal tube.
• Stomach contents can then be safely expelled via
  perforations in the side of the pharyngeal tube.

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Insertion Procedures

• During ventilation observe end-tidal CO2 monitor
  or pulseoximetry to confirm oxygenation

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The End