Holding Instruments Plastic Bougie For Intubation - 60 Cm Length, Compatible With 8.0 Mm Inner Diameter Ett, Facilitates Tube Exchange

The standard gum elastic bougie (GEB) which is used mainly for aiding in difficult laryngoscopy and intubation can be used as a tube exchanger also. The essential steps of tube exchange using GEB require it to be inserted into the lumen of the endotracheal tube (ETT) until the markings of the GEB correlate with the markings on the ETT. This indicates that the tip of the GEB is at the tip of the ETT.[1] Subsequently, cuff of the ETT is deflated and the ETT withdrawn gently over the GEB, whereas the operator end of the GEB is held securely. However, by the time, the tip of the ETT comes to lie in the oral cavity; the whole length of the GEB gets lost within the ETT lumen and the oral cavity resulting in the anaesthesiologist losing control over the GEB completely. This is because the GEB measures 60 cm in length and an ETT of 8.0 mm inner diameter (ID) measures 36 cm [from its distal end to the edge of the blue connector, Figure 1a], thus resulting in only 24 cm of GEB length remaining outside the ETT. Furthermore, the ETT is usually fixed around 2223 cm at the angle of the mouth. Hence, overall 5960 cm length of the GEB is required to be inserted into the ETT (36 cm ETT length and 2223 cm length inside the oral cavity) before the shaft of the GEB could be recovered outside the oral cavity, when the ETT tip comes out. Therefore, invariably the anaesthesiologist ends up losing control over the GEB for a brief while. This total loss of control over the GEB can result in the GEB either migrating deeper into the trachea, thus stimulating the carina in an already/almost awake patient, or there is a risk that the GEB comes out of the larynx along with the ETT and gets accidentally placed in the oral cavity or oesophagus. The traditional airway exchange catheters measure more than 80 cm (83 cm, 11 and 14 G), and, therefore, do not have this problem.[2] As long as the length of the GEB is more than twice that of the ETT, this problem should not happen. Bougies from other manufacturers that measure approximately 70 cm in length are available, and these problems are unlikely to be encountered with these.[3]