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EZ-Blocker ®. Jan. 2010. EZ-Blocker ®. A bronchoscope is mandatory Bronchoscopic control for all in-, and deflations. EZ-Blocker ®. ETT Endotracheal tube EZB EZ-Blocker ® DLT Double Lumen Tube MPA Multiport Adaptor. Preparations. Preparations. Sterile cloth ETT - PowerPoint PPT Presentation
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EZ-Blocker®
Jan. 2010
EZ-Blocker®
A bronchoscope is mandatory
Bronchoscopic control for all in-, and deflations
EZ-Blocker®
ETT Endotracheal tube
EZB EZ-Blocker®
DLT Double Lumen Tube
MPA Multiport Adaptor
Preparations
Preparations Sterile cloth
ETT Lubricant Syringe Marker EZ-Blocker® set
EZB Multiport Adaptor Closing caps CPAP connection piece
Preparations
Inspect for damage Remove protection shaft of the
EZB carefully by pulling the labelat the top of the shaft
Fix 2 blue closing caps on CPAP ports
Inflate cuffs to check for leakage Deflate completely vacuum Lubricate
Preparations
(*)
Preparations
Compare the lengths of EZB withETT plus MPA,place mark on the proximal shaftor remember distance in cm’s
The EZB should wedge on the carina within 8 cm from this mark (*). 4 cm towards the carina and 4 cm to wedge upon the carina
Intubation
Intubation ETT cuff directly behind the vocal cords
ETT tip to carina at least 4 cm
Connect MPA to ETT and start ventilating through MPA Approx. 100% O2
Intubation
Distal end ETT
4 cmCarina
EZB extensions need 4 cm to spread before wedging the carina
EZB placement
(*)
EZB placement First action after intubation Check by
bronchoscope for abnormalities in anatomy Confirm: depth of ETT (4 cm to carina)
Insert EZB through MPA Check under vision closing main stem bronchus
and/or RUL -> if necessary manipulate cuff in right position
EZB placement
Fiberscopic inspection of cuffs
Inflate the cuff in thetarget bronchus until Minimum Occlusive Volume (MOV) has been reached
Deflate the cuff vacuum
EZB Procedure lung collapse Ventilate with deflated cuffs. Approx. 100% O2
Position the patient Disconnect ventilation from MPA as soon as the
surgeon enters the thoracic cavity Lung will collapse
EZB Procedure lung collapse If needed, the surgeon manipulates the lung to
the size of his desire After successful collapse, the cuff is inflated
under vision, start One Lung Ventilation Through resorption lung collapse will improve If collapsed lung starts ventilating again, deflate
cuff and disconnect ventilation -> re-collapse! When lung has the right size -> re-inflate cuff and
restart ventilation -> Always check with scope!
EZB removal
End of operation deflate cuff. Vacuum!
Ventilate carefully to remove all atelectases
Block the other lung for bi-lateral procedure, or remove the EZB
The same ETT is used postoperatively
Essentials
Essentials
ETT cuff must be introduced directly behind the vocal cords
Essentials First action after intubation Bronchoscopy
Confirm: Depth of ETT (4 cm from carina) and location of right upper lobe
If a cuff is not inflated, it should be deflated completely (vacuum)
Both cuffs should never be inflated at the same time †
Essentials After the EZB extends from the ETT, the EZB will
wedge on the carina within ± 8 cm
After wedging the EZB on the carina, the ETT may be advanced a few cm for even more stability
No wedge? Both extensions situated in the same bronchus Check with scope, retry and/or withdraw ETT for
a few cm to provide space for spreading
Essentials
ALWAYS withdraw your scope first
After that removethe EZ-Blocker
NEVER withdrawthe EZ-Blocker first
Essentials
Deflate cuffs completely (vacuum) Carefully ventilate until all atelectases are gone PEEP is needed before wound closure Check lung expansion Remove Bronchoscope first, then the EZB Never jet-ventilate a patient with a EZB in place
-> The lung could be damaged