II. Indications
- Endotracheal Tube Obstruction
- Endotracheal Tube Cuff Rupture
III. Precautions
- High risk procedure
- Be prepared to reintubate
- Have temporizing measures available (e.g. LMA)
IV. Technique: Preparation
-
Endotracheal Tubes
- Two Endotracheal Tubes (size of cuff to replace and one size smaller)
- As usual, test the tube cuffs before use
- Gum Elastic Bougie
- Video Laryngoscope
- Suction
- Bag Valve Mask
- Waveform Capnography
V. Technique: Procedure
-
Procedural Sedation
- Deep Sedation (e.g. Propofol, Ketamine, Etomidate) AND
- Consider Paralytic (e.g. Rocuronium, Succinylcholine)
- Place larygoscope and visualize Endotracheal Tube through Vocal Cords
- Maintain visualization of Vocal Cords throughout procedure
- Endotracheal Tube or bougie maintains position through cords at all times
- Assistant gently inserts Elastic Bougie through Endotracheal Tube
- Do not advance bougie past Endotracheal Tube tip
- Do not apply force when advancing tube
- Remove the Endotracheal Tube after deflating its cuff
- Be careful to leave the bougie in place through cords while removing tube
- Advance new Endotracheal Tube over bougie
- Inflate cuff
- Withdraw bougie
- Check wave form Capnography
VI. References
- Weingart and Swaminathan in Herbert (2020) EM:Rap 20(11): 7-8