COMBITUBE

COMBITUBE It is a double lumen tube that allows blind placement in either the trachea or the esophagus. two adult sizes available 37 Fr and 41 Fr only indications emergency airway management and not for anaesthesia It consists of proximal (oropharyngeal) cuff, inflated with 100ml of air .seals the pharynx by filling the space between the base of the tongue and soft palate , so that no air escapes through the month. The distal cuff ( esophageal/tracheal) inflated with 15ml of air Two lumens fused longitudinally with a universal connector attached to each end. one lumen opens beyond the distal cuff while the other lumen ends between proximal and distal cuff and has 8 ventilating ports located between the two cuffs A distal opening beyond the distal cuff opens in the trachea or esophagus depending on the tube position there are two depth marks on the tube. these two black depth markers should be at the level of incisors INSERTION TECHNIQUE inserted blindly tube enters in esophagus in 95% cases Tube after blind insertion advanced till the 2 black lines are at the level of incisors The proximal cuff is inflated first Ventilate first through the blue tube , if visible chest rise and bilateral air entry then distal cuff in esophagus , and continue the ventilation if ventilation not posible the connect to the white tube , if vsible chest rise then distal lumen in trachea , in this situation you can deflate the proximal cuff and continue the ventilation if ventilation not possible through either lumen , it may be because of obstructionof the larynx by the proximal balloon. The combitube should be withdrawn by 1-2cm and ventilation attempted again CONTRAINDICATIONS upper airway obstruction due to foreign body or tumor patient ingested some corrosive agent Disadvantages possible risk of esophageal rupture sore throat ,dysphagia