Use of Plastic Rod/Sleeve Combination to Facilitate Double- to Single-Lumen. Tracheal Tube Exchange in Patients with Difficult Glottic Visualization

Abstract

To the Editor: For some time, we have used an 80-cm length of 3.2-mm (1/8-in.) diameter nylon rod as an inexpensive double-lumen tracheal tube exchanger. Because sliding a large-diameter tube through the glottic orifice over a narrow guide can be difficult, however, we now use a longer (110 cm) segment of 3.2-mm (1/8-in.) diameter nylon rod (Cadillac Plastic Co., Metairie, LA) in combination with a sleeve consisting of a 72.5-cm length of 4.3-mm inner diameter, 6.4-mm outer diameter high-density polyethylene tubing (e.g., a JEM 400 Endotracheal Tube Exchange Catheter; Instrumentation Industries, Bethel Park, PA) to facilitate double- to single-lumen tube exchange. The rod is cut to length and its ends are smoothed with fine sand paper. Depth of insertion rings are drawn 25 cm from either end of the rod and sleeve using a black marking pen (Figure 1). The rod and sleeve are washed, permitted to dry, packaged together, and gas sterilized.Figure 1: Top, A 110-cm length of 3.2-mm (1/8-in.) diameter nylon rod; middle, a 70-cm high-density polyethylene endotracheal tube exchange catheter; bottom, a 35F double-lumen tracheal tube.After assuring maximal patient oxygenation and neuromuscular blockade, a laryngoscopist inserts a laryngoscope to open the airway and to achieve the best obtainable view of relevant anatomic structures. An assistant then 1) disconnects the double-lumen tube from the breathing circuit, 2) inserts the nylon rod until the first black ring reaches the incisors, 3) withdraws the double-lumen tracheal tube, 4) slides the sleeve over the rod to align the (inserted end) black rings of both at the teeth, 5) removes the rod, and 6) slides the single-lumen tube over the sleeve to the appropriate depth. During the exchange, the laryngoscopist uses a free hand to consecutively stabilize the double-lumen tube, rod, sleeve, and single-lumen tube. Correct position of the single-lumen tube is then verified using accepted methods. The technique should be practiced on a mannequin before it is used in a patient. P. Renae Griffin, MD*[dagger] Mark R. Mitchell, MD* Susheela Viswanathan, MD*[dagger] James M. Riopelle, MD*[dagger] Carol E. Campbell, MD*[dagger] Daniel J. Karpan, RN[double dagger] *Department of Anesthesiology; Louisiana State University Medical Center-New Orleans [dagger]Anesthesia Department; Charity Hospital of New Orleans [double dagger]Charity-Xavier School of Nurse Anesthesiology; New Orleans, LA 70112