COMBITUBE
Airway Management
for Utilizing the
Combitube
Discussion Points
• What is a Combitube?
• Indications
• Contraindications
• Precautions
• Equipment
• Insertion Procedures
– Esophageal Placement
– Tracheal Placement
What is a Combitube?
A double lumen airway device
designed for emergency ventilation
of a patient in respiratory arrest
when visualization of the airway and
endotracheal intubation are not
possible
What is a Combitube?
It is designed to be inserted blindly. The
double lumen design allows effective
ventilations to be provided regardless of
whether esophageal or tracheal
placement is accomplished
Distal balloon Pharyngeal balloon
What is a Combitube?
• The pharyngeal
balloon fills the space
between the tongue
and soft palate,
eliminating the need
for a mask and the
associated face mask
seal problems.
• The patient can be
successfully
ventilated regardless
if the tube is inserted
into the trachea or the
esophagus
)
Indications
• Primary method of airway management
for EMTs (where allowed by local
protocols)
• Respiratory failure in an unconscious
patient without an intact gag reflex
– Cardiopulmonary Arrest
– Respiratory Arrest
• Secondary method of airway
management for paramedics when
orotracheal intubation is not possible
)
Contraindications
• The patient has in intact gag-reflex
• Conscious and unconscious breathing
patients
• The patient has known esophageal
disease
• Known or suspected FBAO of larynx or
trachea
• The patient has an allergy or sensitivity
to latex
(the pharyngeal balloon contains latex)
Precautions
• Take appropriate Body Substance
Isolation (BSI) precautions including
facial protection, as expulsion of stomach
contents can occur through the #2 tube if
the initial placement is in the esophagus.
• DO NOT force the tube. If it does not
advance easily, redirect it or withdraw
and reinsert
• Attach the fluid deflector elbow to the
esophageal tube to deflect stomach
contents away from rescuers
)
Equipment
Full Body Substance Isolation (BSI). Face
mask, eye shield, protective eye-glasses, latex
examination gloves and hepa-mask if patient is
suspected of infectious disease
Equipment
140ml
syringe
Combitube
20ml
syringe
Equipment
Suction device with
FR suction catheter
BVM with oxygen supply
)
Insertion Procedures
• Place the
patient in a
supine position
• Provide
artificial
ventilation via
BVM and
hyperventilate
the patient
with 100%
oxygen prior to
device
insertion
Insertion Procedures
• Inflate both
balloons prior to
insertion to test
the integrity of
the balloons
• Should either
balloon fail after
insertion,
maintenance of
the patient’s
airway cannot be
assured
Insertion Procedures
• Position the
patient’s neck in a
neutral position
(the Combitube is
designed to be
blindly inserted
into the
esophagus)
• Lubricate the tube
with sterile, water
soluble lubricant
• Lift the tongue
and lower jaw
upward to open
the oropharynx
Insertion Procedures
• Insert the
Combitube so
that it curves in
the same
direction as the
natural curvature
of the pharynx
• If resistance is
met, withdraw
tube and attempt
to reinsert
Insertion Procedures
• Advance tube
until the patient’s
teeth are
between the two
black lines
Insertion Procedures
• Inflate the #1
blue pilot cuff
with 100ml of air
from the large
syringe
Insertion Procedures
• Inflate the #2
white pilot cuff
with 15ml of air
from the small
syringe
Insertion Procedures
• Begin ventilation
through the
longer blue tube
labeled #1. If
auscultation of
breath sounds is
good and gastric
inflation is
negative,
continue
Insertion Procedures
• If auscultation of
breath sounds is
absent and
gastric inflation
is positive, then
begin ventilation
through the
shorter clear tube
labeled #2
Esophageal Placement
If the Combitube is
placed in the
esophagus, the distal
balloon will occlude the
esophagus.
Ventilations are then
provided through
perforations in the side
of the pharyngeal tube.
Stomach contents can
then be safely expelled
via the hole in the end
of the tube.
Tracheal Placement
If placed in the trachea,
it functions as an
endotracheal tube, with
the distal balloon
preventing aspiration.
Ventilations are then
provided via the hole in
the end of the tube as
in an endotracheal
tube.
Stomach contents can
then be safely expelled
via perforations in the
side of the pharyngeal
tube.
Insertion Procedures
• During ventilation
observe end-tidal
CO2 monitor and/or
pulseoximetry to
confirm
oxygenation
