Step 1 Place the patients head in neutral position. Open the mouth and depress tongue. Insert the Combitube
airway fat along the tongue. Continue until the patients front teeth are aligned between the depth marks.
Step 2 First, use the large syringe to infate the blue pilot balloon for the large oropharyngeal cuff. Infate to 85 mL (37 Fr) or 100 mL (41 Fr). Then, use the smaller syringe to infate the white pilot balloon for the distal cuff. Infate to 12 mL (37 Fr) or 15 mL (41 Fr). During infation, the Combitube airway might move slightly out of the patients mouth due to the self-adjusting property of the oropharyngeal balloon.
Step 3 Assume esophageal positioning. Attach ventilating device to the longer, blue connecting tube. If auscultation of breath sounds is positive, continue ventilation. Confrm tracheal ventilation with end-tidal CO 2 detection. Use the shorter, clear connecting tube for gastric suctioning.
Step 4 If auscultation of breath sounds is negative, attach breathing device to the shorter, clear connecting tube and ventilate. Confrm tracheal ventilation with auscultation of breath sounds and end-tidal CO 2 detection. The Combitube airway is functioning as a tracheal tube in this case.
Step 5 COMBITUBE
ESOPHAGEAL/TRACHEAL DOUBLE-LUMEN AIRWAY
COVIDIEN, COVIDIEN with Logo and marked brands are trademarks of Covidien AG or an affiliate. 2008 Covidien AG or an affiliate. All rights reserved. B.k 3153v1-1008 AW09306 6135 Gunbarrel Avenue Boulder, CO 80301 USA 303-530-2300 [t] 303-305-2211 [f] www.covidien.com Customer Service 800-635-5267 The Combitube airway is designed for use for up to eight hours. If longer intu ba tion is necessary, replace with a standard endo- tracheal tube. To replace the Combitube airway in esophageal placement with a standard endotracheal tube: Defate 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. Defate the distal cuff through the white pilot balloon and remove carefully, making sure to maintain a patent airway. Available in Two Sizes Size O.D. Use 37 Fr For patients 4 ft to 6 ft (122 to 183 cm) tall 41 Fr For patients more than 5 ft (152 cm) tall Either size can be used with patients between 5 ft and 6 ft tall 37 Fr Either size 41 Fr 4 ft (122 cm) 5 ft (152 cm) 6 ft (183 cm) Pharyngeal lumen Oropharyngeal cuff Due to the material characteristics (e.g. texture) of the oropharyngeal cuff, the Combitube airway requires considerable force to dislodge, ensuring secure placement. 1 Esophageal/tracheal distal cuff The robust distal cuff exhibits zero leakage around the cuff at 30 cm H 2 O simulated gastric pressure. 1 1 Results based on internal testing Depth marks Rounded atraumatic tip Rounded tip is designed to prevent tissue trauma upon insertion. The Combitube airway has been shown to be atraumatic in more than 200 clinical studies. Ventilating eyes Eight ventilation apertures help ensure optimal ventilation. If one of the openings becomes clogged, ventilation can still easily occur through the other seven openings. Esophageal/tracheal lumen