Airway exchange catheter

OVERVIEW

  • aka airway exchange guide
  • examples include the Cook Airway Exchange Catheter and the Aintree Intubation Catheter

USES

  • replacement of an endotracheal tube or tracheostomy tube, when one is already in place
  • Bronchoscope-assisted exchange of a supraglottic airway device (SAD) for an endotracheal tube using the Aintree Intubation Catheter (AIC)

DESCRIPTION

  • Long, thin, flexible catheters with straight rounded tips
  • length markings enable depth of insertion to be determined
  • re-usable and single use models available
  • Sizes: 5, 10, 15 F sizes with varying length (500–700 mm) available for paediatric and adult patients
  • Some have a hollow central lumen with distal side holes and a connector that can attach and enable oxygen insufflation (e.g. Cook Airway Exchanger has 15 mm and jet connections via the Rapi-FitTM adapter at the proximal end)

Aintree Intubation Catheter (AIC) (Cook Medical, USA)

  • an adaptation of the Cook Airway Exchange Catheter with a larger internal diameter
  • 56 cm long hollow catheter
  • has a larger internal diameter (4.7 mm) and is flexible enough to allow it to be pre-loaded onto a pediatric fiberoptic bronchoscope (4.2 mm diameter)
  • external diameter (6.5 mm) allows use with endotracheal tubes with internal diameter of 7 mm or larger, and is stiff enough to allow rail-roading of the endotracheal tube
  • Comes with 2 Rapi-FitTM adaptors that attach to the proximal end

METHOD OF INSERTION/ USE

Endotracheal tube exchange

  • Airway exchange catheter (AEC) is lubricated with water soluble gel
  • AEC is passed through the existing tube into the airway
  • Oxygen insufflation is performed via the AEC until the new ETT is placed
  • The old tube is removed and the new tube is rail-roaded over the catheter as a guide
  • A laryngoscope can be used to optimise the view of the larynx, ensure that the AEC is not dislodged and to displace soft tissues that might resist passage of the new tube.

Bronchoscope-assisted exchange of a supraglottic airway device (SAD) for an endotracheal tube using the Aintree Intubation Catheter (AIC)

  • Apply lubricating gel to the bronchoscope and the AIC
  • Insert the SAD (e.g. Classic LMA, Fastrach iLMA or Proseal) and attach a bronchoscope swivel connector (with access port)
  • An assistant secures the placement of the SAD until it is removed (see below)
  • Under visual guidance, introduce the bronchoscope (with the AIC pre-loaded onto it and taped on to secure it) into the trachea by sequentially visualise SAD aperture bars (if present), glottis, tracheal rings and finally carina as the bronchoscope passes caudally (never pass beyond the carina)
  • Note the depth of the AIC
  • Remove the securing tape then remove bronchoscope leaving the AIC in place
  • Remove the SAD (with swivel connector) leaving the AIC in place (apply counter pressure to the AIC to prevent displacement); grasp the AIC in the mouth as soon as it is visible
  • Check the AIC distance at the lip (ensure never greater than 26 cm)
  • Load the endotracheal tube (minimum size 7-0) over the AIC (eith endotracheal tube tip anterior)
  • Reintroduce the bronchoscope into the AIC to ensure the AIC remains positioned in the trachea during endotracheal tube insertion
  • Advance the endotracheal tube into the trachea while holding the AIC securely in place
  • Remove the AIC and confirm endotracheal tube placement with ETCO2 monitoring

COMPLICATIONS

  • Airway trauma
  • failure to insert a new tube over the catheter
  • accidental dislodgement during removal of the endotracheal tube

OTHER INFORMATION

  • a bougie can be used for ETT replacement if an AEC is not available
  • Unlike blind introduction of a bougie, the AIC loaded over a bronchoscope allows visually directed placement and avoids trauma
  • The AIC is not recommended for use with the LMA Supreme
  • Oxygen insufflation can be performed via AECs, but ventilation is inadequate

VIDEO

Video by Nick Brown and Andy Heard demonstrating bronchoscope-assisted exchange of a supraglottic airway device (SAD) for an endotracheal tube using the Aintree Intubation Catheter (AIC)


References and Links

FOAM and web resources


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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