Guide
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Best Practice Training Guide
Authorised EU Representative: LMA Deutschland GmbH, Mildred-Scheel-Strasse 1, 53175 Bonn, Germany Tel +49 (0) 228 1800 180 Fax +49 (0) 228 1800 181 Email: [email protected] www.LMACO.com Authorised Representative in USA: LMA North America Inc, 4660 La Jolla Village Drive, Suite 900, San Diego CA. 92122 Tel (800) 788-7999 Fax (858) 622-4130 Email: [email protected] www.LMACO.com Issue: PAK2100009a
Pre-use (LMA CTrach™ system) 1. Select LMA CTrach™ Airway (Airway) size using recommended LMA™ size selection. 2. Fully deflate the Airway into the recommended profile. 3. Pre-lubricate the Airway with the lubricated ETT. Do not pass the ETT beyond the Epiglottic Elevator Bar (EEB). 4. Clean the fibreoptics in the magnetic latch connector with an alcoholic wipe. 5. Apply anti-fogging solution (if necessary) to the fibreoptic distal end located in the bowl of the mask e.g. Clear Vue, FRED™. 6. Focus the Airway and LMA CTrach™ Viewer (Viewer) using the pre-focus card. When focusing reduce the ‘light output’ until there is no glare on the screen. NO FURTHER FOCUS ADJUSTMENT IS REQUIRED DURING USE
Pre-insertion (Patient) 1. Achieve sufficient depth of anaesthesia. 2. Suction the patient’s airway if appropriate.
During Use 1. Insert Airway using the recommended insertion technique making sure the patient’s head is in the neutral position. 2. Inflate Airway to recommended inflation volumes to a maximum intra-cuff pressure of 60cm H20. 3. Ventilate and secure patient’s airway.
Note: Ventilation helps to move anatomy out of the way and improve the view. 4. Attach the Viewer to the Airway (Check there is a positive connection between the Airway and the Viewer, with no interference from the catheter mount). 5. If the view is dark: increase the light output. 6. If a view of vocal cords is obtained: perform the intubation. If no view go to point 7 7. If no view of vocal cords is obtained: the following procedures can be performed to obtain a view (repeat as necessary): - Up-down manoeuvre (swing the airway outwards 6cm and re-insert to same position [Figure.1]) Figure 1: To overcome a downfolded epiglottis, swing the device outwards about 6cm and then replace. a The downfolded epiglottis b Using the inflated mask as a hook to elevate the epiglottis “up movement” c Replacing mask “down movement”
- Distal manoeuvre (push the mask slightly further in so that the tip of the cuff moves towards the oesophageal sphincter) - Side to side manoeuvre - Chandy manoeuvre (lifting action to increase seal pressure and optimise alignment between axes of the trachea and the ETT [Figure. 2] Figure 2: Use the handle to gently lift the device 2-3mm in the direction shown by the arrow as the ETT tube is advanced.
- Use a suction catheter if mucous is present on the lens (whiteout that does not change with manoeuvres) 8. Procedure if no view is achieved: - Pass the ETT to 1cm beyond the 15cm depth marker on the ETT to lift the EEB.