7E Supraglottic Airway - acidremap.com

M Health Fairview EMS Medical Operations Manual

7E Page 1 of 5 Version 2020.1

7E SUPRAGLOTTIC AIRWAY

PATIENT CARE GOALS

• To provide a patent airway for patients in which endotracheal intubation has failed or is not indicated. 1

• A supraglottic airway is contraindicated in;

o Intact gag reflex

o Patient’s height less than manufacture’s recommendation for device

o Caustic substance ingestion

o Known or suspected airway burn

o Anaphylaxis with respiratory symptoms

o Known or suspected airway obstruction

1. Don the appropriate personal protective equipment. Gloves and eye protection are the minimum required protection. Additionally, a facemask is required if there is a likelihood of encountering blood in the airway.

i-gel/i-gel Resus 1. Prepare the following equipment:

Appropriately sized i-gel using patient’s ideal body weight

Water based lubricant

Suction

Airway strap or tape

In-line capnography

2. Begin preoxygenation of the patient.

3. Open the i-gel package and take out the protective cradle containing the device. Remove the i-gel

from the protective cradle and if an O2 Resus i-gel, remove the accessory pack containing the sachet

of lubricant and airway support strap. Keep the cradle readily available.

4. Place a small bolus of lubricant directly onto the protective cradle and while holding the i-gel along

the bite block, lubricate the back, sides, front, and tip of the cuff with a thin layer of lubricant.

5. Place the patient into a sniffing position with the head extended and the neck flexed. The chin

should be gently pressed down before proceeding. Perform a tongue-jaw lift or modified jaw thrust

when applicable.

EMT



6. Begin introducing the i-gel towards the patient’s mouth positioning the device so the i-gel cuff outlet

is facing towards the chin of the patient.

7. Insert the leading soft tip into the mouth of the patient in a direction towards the hard palate.

8. Glide the device downwards along the hard palate with a continuous gentle push until a definitive

resistance is felt and the device is in position.

9. The tip of the i-gel should be located into the upper esophageal opening and the cuff should be

located against the laryngeal framework.

10. The patient’s teeth or gums should be resting on the integral bite-block.

11. Ventilate the patient and confirm placement by ETCO2 waveform capnography, auscultating lung

sounds, watching for chest rise, and SpO2.

12. Secure the i-gel using the support strap for the adult sized O2 Resus and secure the pediatric i-gel

using tape secured from maxilla to maxilla.2

The i-gel O2 Resus Pack

Open the i-gel O2 package and take out the protective cradle containing the device. Remove the accessory pack containing the sachet of lubricant and airway support strap from the protective cradle and place to one side.

1.Remove the i-gel O2 and transfer it to the palm of the same hand that is holding the protective cradle, supporting the device between the thumb and index finger.

2.Open the sachet of supplied lubricant and place a small bolus onto the middle of the smooth surface of the protective cradle in preparation for lubrication. Do not use silicone based lubricants.

3.

Grasp the i-gel O2 with the opposite (free) hand along the integral bite block and lubricate the back, sides and front of the cuff with a thin layer of lubricant.

4. Place the i-gel O2 back into the protective cradle in preparation for insertion.

5.

Remove the i-gel O2 from the protective cradle. Grasp the lubricated i-gel O2 firmly along the integral bite block. Position the device so that the i-gel O2 cuff outlet is facing towards the chin of the patient. The patient should be in the ‘sniffing the morning air’ position with head extended and neck flexed. The chin should be gently pressed down before proceeding. Introduce the leading soft tip into the mouth of the patient in a direction towards the hard palate.

6.

Important notes to the recommended insertion techniqueSometimes a feel of ‘give-way’ is felt before the end point resistance is met. This is due to the passage of the bowl of the i-gel O2 through the faucial pillars. It is important to continue to insert the device until a definitive resistance is felt.

Once definitive resistance is met and the teeth are located on the integral bite block, do not repeatedly push the i-gel O2 down or apply excessive force during insertion.

It is not necessary to insert fingers or thumbs into the patient’s mouth during the process of inserting the device.

I-GELO2POSTER_US issue 2 01.17

Preparations for use

Insertion technique

Visit the i-gel website www.i-gel.com

The i-gel O2 should be taped down from ‘maxilla to maxilla’ or secured with the support strap provided.

Glide the device downwards and backwards along the hard palate with a continuous but gentle push until a definitive resistance is felt.

The tip of the airway should be located into the upper esophageal opening (a) and the cuff should be located against the laryngeal framework (b). The incisors should be resting on the integral bite-block (c).

7.

a

b

c8.

The strap should be slid under the patient’s neck until the wide central band of the strap is located directly under the neck of the patient. One end of the strap should then be lifted over the patient’s face and secured to the i-gel O2 by placing an appropriate hole on the strap over the lug of the hook ring located at the top of the integral bite block. The other end of the strap should then be lifted over the other side of the patient’s face and secured in the same manner, ensuring there is sufficient tension to hold the i-gel O2 securely in place, but not an excessive tension that may cause trauma to the patients neck or face or that may cause unwanted downward pressure of the i-gel O2.

6757 Kinne Street, East Syracuse, New York 13057315-451-2900 or 800-828-9633 [email protected] www.intersurgical.com

Patient Size i-gel® Size

Patient Weight Guidance

Small adult 3 30-60kg(65-130lbs)

Medium adult 4 50-90kg (110-200lbs)

Large adult 5 90+kg (200 +lbs)

This poster does NOT constitute a comprehensive guide to the preparation, insertion and use of the i-gel O2. The user should first familiarise themselves with the Instructions for Use supplied with the product before attempting to use the i-gel O2. The i-gel must always be separated from the protective cradle prior to insertion. The cradle is not an introducer and must never be inserted into the patient’s mouth.The i-gel O2 has been designed to facilitate ventilation as part of standard resuscitation protocols, such as those designated by the European Resuscitation Council (ERC) and the American Heart Association (AHA). However, the i-gel O2 incorporates a supplementary oxygen port, so can also be used for the delivery of passive oxygenation, or Passive Airway Management™ (PAM), as part of an appropriate CardioCerebral Resuscitation (CCR) protocol. For more information on passive oxygenation, please refer to the instructions for use or contact us.

Taping Airway support strap



AirQ

2. Prepare the following equipment:

• Appropriately sized AirQ (generally a 3.5 for women and 4.5 for men) 3

• Water based lubricant

• Suction

• In-line capnography

3. Pre-oxygenate the patient.

4. Lubricate the back of the AirQ and front ridges of mask cavity.

5. Perform a tongue-jaw lift and insert the AirQ into the mouth with the tip of the mask pointing down, toward the back of the patient’s throat4.

6. Use a gentle, downward pressure to slide the device into position.

7. If the Air-Q becomes stuck during placement, slide a finger behind the mask and guide the mask around the curve of the tongue.

8. Check position of Air-Q to ensure correct sizing. Patient’s incisors should be between the two horizontal marks on the Air-Q.

Properly sized and/or placed AirQ Improperly sized and/or placed AirQ

9. Ventilate the patient and confirm placement by auscultating lung sounds, watching for chest rise, and looking for an appropriate capnography waveform.

King LT

2. While maintaining ventilation with OP airway and BVM, assemble the equipment to be used.

3. Choose correct size of airway based on patient’s height.

a. #5 for over 6 feet

b. #4 for 5-6 ft

c. #3 for 4-5 ft

d. #2.5 for 41-51 inches or 25-35 kg (Only available in LT-D)



e. #2 for 35-45 inches or 12-25 kg (Only available in LT-D)

4. Test the cuff inflation system by injecting the maximum volume of air recommended into the cuff.

a. #5 LT-D 70-90 ml, LTS-D 60-80 ml

b. #4 LT-D 60-80 ml, LTS-D 50-70 ml

c. #3 LT-D 45-60 ml, LTS-D 40-55 ml

d. #2.5 LT-D 30-40 ml

e. #2 LT-D 25-35 ml

f. Remove all air from cuffs before inserting.

5. Apply a water based lubricant to the beveled distal tip and posterior aspect of the tube, taking care to avoid introduction of lubricant in or near the ventilation openings.

6. Remove potential airway obstructions such as dentures.

7. Pre-oxygenate the patient.

8. Place patient’s head in neutral position. If unable to pass King LT-D place the head in a sniffing position by placing a pad under the head raising it approximately 2 inches.

9. Hold the King LT-D at the connector with the dominant hand. With the non-dominant hand, grasp the patients tongue and lower jaw and lift upward.

10. Rotate the airway laterally 45-90 degrees such that the blue orientation line is touching the corner of the mouth, introduce the tip into the mouth and advance behind the base of the tongue.

11. As the tube tip passes over the tongue, rotate the tube back to the midline so that the blue orientation line faces the patient’s chin.

12. Without exerting excessive force, advance the airway until the base of the connector is aligned with the teeth or gums.

13. Use a syringe to inflate the cuff with the minimum volume necessary to seal the airway at peak ventilation pressure.

14. Gently ventilate the patient to assess compliance while simultaneously withdrawing the airway until ventilation is easy and free flowing.

15. Confirm proper position by auscultation, chest rise, and capnography.

16. If tube misplacement is suspected remove the airway and resume ventilation with BVM.

17. Readjust cuff inflation pressure to seal airway.

18. Secure King LT-D to patient using commercial holder. Apply a C-collar to prevent head movement and tube dislodgment.

• Rationale for use of the Air-Q.

• Initial and on-going assessment of the patient’s airway.

DOCUMENTATION KEY POINTS



• Size of Air-Q inserted.

• Number of attempts, successes, and any complications encountered.

1 A supraglottic airway should be considered the airway of choice for the crash intubation or as a rescue airway following failed attempts to place an endotracheal tube.

2 The support strap should be slid under the patient’s neck until the wide central band of the strap is located directly under the neck of the patient. One end of the strap should then be lifted over the patient’s face and secured to the i-gel O2 by placing an appropriate hole on the strap over the lug of the hook ring located at the top of the integral bit block. The other end of the strap should then be lifted over the other side of the patient’s face and secured in the same manner, ensuring there is sufficient tension to hold the i-gel securely in place. Do not place excessive tension on the support strap that may cause trauma to the patients neck or face or that may cause unwanted downward pressure of the i-gel.

3 AirQ Sizing Chart

4 A tongue blade may also be used to elevate the tongue and allow easier insertion of the Air-Q.

NOTES

Ideal Body Weight AirQ Size 70-100 kg 4.5 50-70 kg 3.5 30-50 kg 2.5 17-30 kg 2.0 7-17 kg 1.5 4-7 kg 1.0 <4 kg 0.5

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7E Supraglottic Airway - acidremap.com