Older King tubes are contoured such that virtually all insertions enter the esophagus. The ventilating lumen of the King tube is suitable for stylet insertion to facilitate conversion of the King tube to an endotracheal tube.
However, visualization of the glottis through this lumen is often impossible. Aligning the ear with the sternal notch may help open the upper airway and establishes the best position to view the airway if endotracheal intubation becomes necessary. The degree of head elevation that best aligns the ear and sternal notch varies depending on the patient's age and body habitus.
Place folded towels or other materials under the head, neck, and shoulders, flexing the neck so as to elevate the head until the external auditory meatus lies in the same horizontal plane as the sternal notch. Then, tilt the head so that the face aligns on a parallel horizontal plane; this second plane will be above the first.
See also Airway Establishment and A: The head is flat on the stretcher; the airway is constricted. B: Establishing the sniffing position, the ear and sternal notch are aligned, with the face parallel to the ceiling, opening the airway.
Position the patient supine or at a slight incline on the stretcher. Avoid moving the neck and use only the jaw thrust maneuver How To Do Head Tilt—Chin Lift and Jaw-Thrust Maneuvers Part of pre-intubation and emergency rescue breathing procedures, the head tilt—chin lift maneuver and the jaw-thrust maneuver are 2 noninvasive, manual means to help restore upper airway patency Pre-oxygenate the patient with bag-valve-mask ventilation How To Do a Percutaneous Cricothyrotomy Cricothyrotomy, whether traditional surgical cricothyrotomy or percutaneous cricothyrotomy using a guidewire, uses an incision through the skin and cricothyroid membrane through which an artificial This information is on the tube packaging and the cuff of the tube itself.
Lift the chin and tongue with your non-dominant hand. Grasp the tongue and chin between your thumb inside the mouth and your fingers on the underside of the chin, and lift up. Insert the King tube initially at the corner of the mouth 45 to 90 degrees of rotation off-center, and then rotate it to midline position when the tip of the tube is past the tongue.
Do not force either tube; you may cause soft tissue damage. If resistance is encountered, pull back somewhat and re-advance the tube, trying to follow the posterior pharyngeal wall. You may need to remove the tube, alter its curvature, and then reinsert it. At the proper distance of insertion as confirmed by markings on the tube , the proximal ventilating lumen will open over the laryngeal opening, and the distal lumen will have entered the esophagus in most cases.
Inflate the cuffs. Assess lung ventilation by auscultation and chest rise. Check end-tidal carbon dioxide to confirm tube placement. However, during cardiac arrest, capnometry may not reliably indicate proper tube placement. 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. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here.
Common Health Topics. Videos Figures Images Quizzes Symptoms. Additional Considerations. Relevant Anatomy. Step-by-Step Description of Procedure. Warnings and Common Errors. Unable to ventilate patient through either connector. Webauthor: E. Liem Consultants: D. Gravenstein Contributor: T.
All rights reserved. None of the anaesthesia information on this website should be considered a substitute to medical consultation. In accordance with University of Florida policy , there is no advertising on this site. This site complies with the University of Florida's internet privacy policy. Terms of Use. Left side. Right side. Induce patient as if for regular intubation. Make sure the Combitube is not per chance in the trachea.
Attempt to ventilate through connector number 2, if breath sounds are heard over the lungs then the combitube has been placed in the trachea instead of the esophagus. Deflate the large proximal pharyngeal cuff and use the Combitube as a regular ETT. Confirm that the combitube has been placed in the esophagus by listening for epigastric gurgling sounds while ventilating through connector number 2.
Then withdraw the combitube cm at a time while ventilating through connector number 1 until breath sounds are heard over the lungs. The most common cause of this inability to ventilate to ventilate through either connector is an excessive insertion depth of the combitube relative to the patient.
This will cause obstruction of the glottic opening by the large proximal pharyngeal cuff 1,5. Insertion of the Combitube airway with the cervical spine immobilised in a rigid cervical collar. Is the Combitube a useful emergency airway device for anesthesiologists?
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