Review Note
Last Update: 02/18/2025 12:27 AM
Current Deck: ACG Part 2::Thoracic SSU
New Card (Unpublished)Currently Published Content
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Commit #285028
SS_TS 1.9 Describe the different methods available to perform lung isolation including the use of double-lumen tubes, bronchial blockers, single lumen tubes and Univent tubes and the rationale for selecting different methods in different situations (refer to the Paediatric anaesthesia specialised study unit for issues specifically pertaining to paediatric patients)
- Bronchial Blockers
- Bronchial Blockers
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Commit #285028Bronchial blockers
- Types of bronchial blockers
- Univent; SLT with enclosed bronchial blocker
- Arndt wire guided
- Cohen Flexitip
- EZ Blocker - 2 cuff, Y shaped distally
- 9 Fr sized bronchial blocker appropriate for most adults; needs at least a size 8 SLT to accommodate BB and bronchoscope
- Arndt wire guided BB available on L4 ACH
Bronchial blocker insertion:
(i) Assemble and check the multiport airway adapter. Lubricate and place the bronchoscope and blocker into their respective ports. The blocker hub has a tightening screwdleave this loose at this point.
(ii) Intubate the patient’s trachea and confirm ventilation of the lungs. Use the bronchoscope to position the tip of the tube 1 cm from the carina and identify the right and left main bronchi.
(iii) Manually thread the bronchoscope tip through the loop of the blocker. Connect the multiport airway adapter to the tracheal tube. Connect the breathing system to the side port. Tighten the blocker hub to prevent air leak.
(iv) Advance the bronchoscope to the carina, identifying the trachealis muscle posteriorly. Verbally confirm the side you intend to block and advance the bronchoscope down the chosen bronchus.
(v) Untighten the hub and advance the blocker down the trachea and into the bronchus. Withdraw the bronchoscope to the carina to visualise both bronchi and confirm the position of the blocker within the chosen bronchus. Note the depth on the blocker and secure the mount and blocker hub
(vi) To deflate the lung, disconnect the breathing system in expiration and inflate the BB cuff under bronchoscopic view (6e12 ml of air). Confirm the inflated cuff is correctly positioned in the proximal bronchus. If not inserted sufficiently far into the bronchus, inflating the cuff can cause the cuff to herniate into the trachea. Reconnect the breathing system and withdraw the inner wire of the blocker. If the blocker has been repositioned from Step (v), note the new depth.
The correct position of the blocker must be confirmed with bronchoscopy whenever the patient is repositioned.
