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
CCC Airway Series
Emergencies: Can’t Intubate, Can’t Intubate, Can’t Oxygenate (CICO), Laryngospasm, Surgical Cricothyroidotomy
Conditions: Airway Obstruction, Airway in C-Spine Injury, Airway mgmt in major trauma, Airway in Maxillofacial Trauma, Airway in Neck Trauma, Angioedema, Coroner’s Clot, Intubation of the GI Bleeder, Intubation in GIH, Intubation, hypotension and shock, Peri-intubation life threats, Stridor, Post-Extubation Stridor, Tracheo-esophageal fistula, Trismus and Restricted Mouth Opening
Pre-Intubation: Airway Assessment, Apnoeic Oxygenation, Pre-oxygenation
Paediatric: Paediatric Airway, Paeds Anaesthetic Equipment, Upper airway obstruction in a child
Airway adjuncts: Intubating LMA, Laryngeal Mask Airway (LMA)
Intubation Aids: Bougie, Stylet, Airway Exchange Catheter
Intubation Pharmacology: Paralytics for intubation of the critically ill, Pre-treatment for RSI
Laryngoscopy: Bimanual laryngoscopy, Direct Laryngoscopy, Suction Assisted Laryngoscopy Airway Decontamination (SALAD), Three Axis Alignment vs Two Curve Theory, Video Laryngoscopy, Video Laryngoscopy vs. Direct
Intubation: Adverse effects of endotracheal intubation, Awake Intubation, Blind Digital Intubation, Cricoid Pressure, Delayed sequence intubation (DSI), Nasal intubation, Pre-hospital RSI, Rapid Sequence Intubation (RSI), RSI and PALM
Post-intubation: ETT Cuff Leak, Hypoxia, Post-intubation Care, Unplanned Extubation
Tracheostomy: Anatomy, Assessment of swallow, Bleeding trache, Complications, Insertion, Insertion timing, Literature summary, Perc. Trache, Perc. vs surgical trache, Respiratory distress in a trache patient, Trache Adv. and Disadv., Trache summary
Misc: Airway literature summaries, Bronchoscopic Anatomy, Cuff Leak Test, Difficult airway algorithms, Phases of Swallowing
FOAM and web resources
- Fibreoptic guided tracheal intubation through SAD using Aintree intubation catheter (DAS Guideline)
- Turk M, Gravenstein D (2007): Aintree Intubation Catheter Technique in Unanticipated Difficult Intubation. Retrieved 28 January 2015, from University of Florida Department of Anesthesiology, Center for Simulation, Advanced Learning and Technology, Virtual Anesthesia Machine Web site: http://vam.anest.ufl.edu/airwaydevice/aintree/index.html
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a 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 three amazing children.
On Twitter, he is @precordialthump.
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