COMBITUBE

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#MedtimewithDrmuneerjan • COMBITUBE • It is a double lumen tube that allows blind placement in either the trachea or the esophagus. • two adult sizes available 37 Fr and 41 Fr only • indications • emergency airway management and not for anaesthesia • It consists of proximal (oropharyngeal) cuff, inflated with 100ml of air .seals the pharynx by filling the space between the base of the tongue and soft palate , so that no air escapes through the month. • The distal cuff ( esophageal/tracheal) inflated with 15ml of air • Two lumens fused longitudinally with a universal connector attached to each end. one lumen opens beyond the distal cuff while the other lumen ends between proximal and distal cuff and has 8 ventilating ports located between the two cuffs • A distal opening beyond the distal cuff opens in the trachea or esophagus depending on the tube position • there are two depth marks on the tube. these two black depth markers should be at the level of incisors • INSERTION TECHNIQUE • inserted blindly tube enters in esophagus in 95% cases • Tube after blind insertion advanced till the 2 black lines are at the level of incisors • The proximal cuff is inflated first • Ventilate first through the blue tube , if visible chest rise and bilateral air entry then distal cuff in esophagus , and continue the ventilation • if ventilation not posible the connect to the white tube , if vsible chest rise then distal lumen in trachea , in this situation you can deflate the proximal cuff and continue the ventilation • if ventilation not possible through either lumen , it may be because of obstructionof the larynx by the proximal balloon. The combitube should be withdrawn by 1-2cm and ventilation attempted again • CONTRAINDICATIONS • upper airway obstruction due to foreign body or tumor • patient ingested some corrosive agent • Disadvantages • possible risk of esophageal rupture • sore throat ,dysphagia

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