critical care medicine
How To Insert an Esophageal Tracheal Double Lumen Tube (Combitube) or a King Laryngeal Tube
Warnings and Common Errors for Combitube or King Laryngeal Tube Insertion
In about 5% of Combitube insertions, the distal tube will enter the trachea; in this case, ventilation can be done through the distal tube. In up to 10% of insertions of newer King tubes, the distal tube will enter the trachea; adequate ventilation may be possible through the distal tube. Generally, supraglottic airways should be inserted only in patients who are unresponsive; otherwise, aspiration is a risk. Do not allow a patient to awaken during insertion or ventilation with a supraglottic airway. If necessary, prevent the patient from waking up or gagging (using paralytics, adequate analgesia, and sedation), or remove the airway as clinically indicated. Placing the dual lumen tubes too deeply may cause the balloon to obstruct the tracheal opening and inhibit ventilation. Obstruction can be remedied by pulling the airway back a few centimeters. 