Potential Adverse Events - COOK Medical Aintree Catheter Mode D'emploi

POTENTIAL ADVERSE EVENTS

• Barotrauma
• Pneumothorax
• Hypoxia
• Perforation of the trachea, bronchi, or lung parenchyma
• Injury to the epiglottis
• Catheter dislodgment or migration
• Failed endotracheal tube placement
INSTRUCTIONS FOR USE
Bronchoscopic Assisted Exchange/Intubation
1. After a superglottic airway device (SAD) has been placed, if the patient
requires a single-lumen ETT, proceed to add the double swivel connector
into the anesthetic circuit, if not already present. (Fig. 1) This allows the
patient to be adequately ventilated during the bronchoscopic intubation
procedure. NOTE: Ventilation should be continued during the exchange
process, through the double swivel connector. Discontinue ventilation
only during the actual exchange over the AIC.
2. Lubricate the bronchoscope using sterile medical-grade lubricant
approved for use in the airway, according to hospital protocol.
3. Place the appropriately sized bronchoscope through the AIC and tape
the catheter securely to the scope. NOTE: The catheter should slide easily
onto the scope. If it does not slide easily, there is a risk that the catheter
may become lodged on the bronchoscope and cause damage. The distal
3-4 cm of the bronchoscope should extend beyond the distal tip of the
AIC. This allows adequate tip deflection of the bronchoscope.
4. While maintaining adequate ventilation, pass the bronchoscope and
AIC assembly through the bronchoscopic port of the double swivel
connector. (Fig. 2)
5. Direct the bronchoscope and AIC assembly through the vocal cords and
down toward the carina.
6. While maintaining constant position of the AIC, remove the
bronchoscope. Leave the AIC and the SAD in situ.
7. Deflate the cuff of the SAD (if applicable). While maintaining constant
position of the AIC, remove the SAD, leaving just the AIC in the trachea.
(Fig. 3)
8. Using sterile lubricant, lubricate the proximal end of the AIC, and load the
ETT onto the AIC's proximal end.
9. While maintaining the position of the AIC, use the outer margin of
the patient's mouth as a landmark and advance the ETT over the AIC
into appropriate position within the trachea. (Fig. 4) NOTE: It may
be necessary to rotate the ETT 90 degrees counter-clockwise while
advancing it. This will position the bevel of the tube toward the anterior
aspect of the vocal cords.
10. Hold the endotracheal tube in position and remove the AIC.
11. Inflate the cuff of the endotracheal tube. Reestablish ventilation and
secure the new ETT in place.
12. Reinsert the bronchoscope to confirm the correct position of the ETT.
13. Remove the bronchoscope.
Endotracheal Tube Exchange
1. Before advancing the Aintree Intubation Catheter (AIC) into the
endotracheal tube (ETT) to be replaced, confirm correct ETT position.
2. Using the outer margin of the patient's mouth or nasal orifice as a
landmark, note the marking on the ETT. A piece of tape or other marker
may be placed on the AIC at the corresponding distance from the tip to
aid in correct placement within the ETT.
3. Advance the AIC, sideported end first, into the ETT to be replaced. (Fig. 5)
NOTE: It is recommended that a sterile lubricant or sterile water be
applied to the orifice of the ETT prior to introduction of the AIC.
4. Properly position the AIC within the ETT by aligning the appropriate
centimeter mark on the AIC with the corresponding centimeter mark
on the ETT. This placement is determined by visualizing the indicated
centimeter length of the ETT, in place, as shown on its surface scale. (For
example, an ETT that has been shortened to 24 cm should have the 24 cm
marker of the AIC aligned at the 24 cm mark of the ETT.)
5. Fully deflate the cuff of the ETT. While maintaining the position of the AIC,
remove the ETT, leaving the AIC in place. (Fig. 6)
6. While maintaining the position of the AIC, use the patient's mouth or
nasal orifice (depending on approach) as a landmark and advance the
new ETT over the AIC into appropriate position. (Fig. 7)
NOTE: It is recommended that a sterile lubricant be applied to the tip of
the ETT prior to advancing the ETT.
7. Remove the AIC and inflate the cuff of the new ETT. Reestablish
ventilation and secure the new ETT in place. Confirm the new ETT's
position using standard methods (e.g., capnography, breath sounds, and
chest x-ray). (Fig. 8)
Use of the Rapi-Fit® Adapter
Rapi-Fit adapters should only be used when oxygen requirements are
high and intubation is unsuccessful. Use of an oxygen source should only
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