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It is a supraglottic airway device that can provide an emergency airway when conventional means are not effective or possible . The combitube has two lumens so that it can function appropriately whether placed in trachea or oesophagus.

It also has oesophageal ballon to provide protection from aspiration , which is an advantage over LMA.

It has been sucessfully used in cardiopulmonary resustiation.

Care must taken not to place it deep in oesophagus which may obstruct the glottic opening.

CONTRAINDICATION

• Height less than 5 feet

• Oesophageal disease

• Intact gag reflex

• Caustic ingestion

INSERTION OF THE COMBITUBE

• Place the patients head in neutral position.

• The tongue and mandible is lifted with one hand and combitube is inserted in the direction of of the normal curvature of the pharynx with the other hand. Continue until the printed ring is aligned with the teeth.

• First, use the large syringe to inflate the blue pilot balloon for the large oropharyngeal cuff. Inflate to 85 mL (37 Fr) or 100 mL (41 Fr). Then, use the smaller syringe to inflate the white pilot balloon for the distal cuff. Inflate to 12 mL (37 Fr) or 15 mL (41 Fr).

• During inflation, the Combitube airway might move slightly out of the patient’s mouth due to the self-adjusting property of the oropharyngeal balloon.

• Assume esophageal positioning. The tube is placed in oesophagus as designed almost 100% of time.Attach ventilating device to the longer, blue connecting tube. If auscultation of breath sounds is positive, continue ventilation.

• Confirm tracheal ventilation with end-tidal CO2 detection.

• Use the shorter, clear connecting tube for gastric suctioning.

• If auscultation of breath sounds is negative, attach breathing device to the

  shorter, clear connecting tube and ventilate.

• Confirm tracheal ventilation with auscultation of breath sounds and end-tidal

  CO2 detection. The Combitube airway is functioning as a tracheal tube in this case .

The combitube can only be placed in position for a maximum of 8 hrs.

• Deflate the oropharyngeal cuff through the blue pilot balloon.

• Move the Combitube airway to the left side of the mouth.

• Intubate with an endotracheal tube using currently accepted medical techniques .

• Deflate the distal cuff through the white pilot balloon and remove carefully, making sure to maintain a patent airway.

NOTE : The combitube has virtually no role in emergency department as a primary airway management device except in cardiopulmonary arrest when expertise for endotracheal intubation is not available. ED its use may be restricted to rescue placement after failed intubation with adequate BMV or in a can't intubate can't oxygenate patient.

REFERENCE

• ROSENS EMERGENCY MEDICINE

• MILLERS : TEXTBOOK OF ANESTHIESOLOGY

EDITED BY : Dr. Ajith Kumar J;

Update on 7/05/2012.