NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5336

POLICIES AND PROCEDURES

Subject: Medical Control

Combitube Airway

Associated Policies: 5303, 5402, 6504 06/22/97

  1. Indications:
  1. Unconscious patient with absent gag reflex who is apneic or hypoventilating.
  2. Unable to perform endotracheal intubation.
  1. Contraindications:
  1. Patient who appears under sixteen (16) years old.
  2. Patient under five (5) feet tall.
  3. Know esophageal disease. (cancer, varices, surgery, etc.)
  4. Ingestion of caustic substance.
  5. Suspected narcotic overdose prior to administration of Naloxone.
  1. Equipment:
  1. Combitube Airway.
  2. 100 + cc syringe for inflation of pharyngeal cuff.
  3. 20 cc syringe for inflation of distal cuff.
  4. Water soluble lubricant.
  5. Stethoscope.
  6. Portable suction device.
  1. Insertion Procedure:
  1. Inflate each cuff and check for leaks, apply emesis diverter to tube # 2.
  2. Deflate cuffs.
  3. Apply water soluble lubricant to distal end of tube.
  4. Hyperventilate patient.
  5. Place patient’s head in a neutral position.
  6. Grab lower jaw and lift upward.
  7. Insert tube; advance until teeth / gums are between black rings on tube.
  8. Inflate pharyngeal cuff (Port # 1 with blue pilot balloon ) with 100 cc of air.
  9. Inflate distal cuff (Port # 2 with white pilot balloon ) with 15 cc of air.
  10. Ventilate through TUBE # 1.
  11. Assess ventilation:
  12. Rise and fall of the chest.
  13. Bilateral lung sounds.
  14. Gastric auscultation.
  1. If CHEST RISE is present and GASTRIC SOUNDS are absent:
  1. Secure tube.
  2. Verify placement.
  3. Continue ventilation.
  1. If NO CHEST RISE and GASTRIC SOUNDS are present:
  1. Remove the emesis diverter and ventilate on TUBE # 2.
  2. Assess ventilation as above.
  1. If unable to confirm placement via either tube:
  1. Remove Combitube.
  2. Continue ventilations with mask.
  1. Special Information:
  1. The Combitube will enter the esophagus 85% of the time, so inflation with tube # 1 is ordinary.
  2. If ventilation is through tube # 2 then the tube is in the trachea and tube # 2 may be used for medication administration and suctioning just as if it were an ordinary ET tube.
  3. The Combitube must be removed in order to re attempt endotracheal intubation.
  4. An intubation attempt should not take longer than 30 seconds.
  5. Removal of the Combitube should be accomplished with the patient on their side and suction immediately available.
  6. If resistance is met when advancing the tube then the attempt should be discontinued.