Combitube Removing or Replacing

1.  Perform hand hygiene and apply clean gloves and eye protection.
2.  Assess for the need to replace the Combitube™ with an endotracheal tube.
3.  Prepare, assemble, and check all equipment before initiating replacement procedure.
4.  Ensure that suction is functioning and available at the bedside.
5.  To replace the Combitube™ when ventilating through the long, blue tube:
  a.  Decompress the stomach by placing a suction catheter or a nasogastric tube through the shorter, clear tube.
  b.  Preoxygenate the patient.
  c.  Remove all air from the proximal, pharyngeal (blue) cuff using the 140-ml syringe.
  d.  Position the Combitube™ to the left side of the mouth. Insert the laryngoscope and intubate the trachea, with the Combitube™.
  e.  Deflate the distal esophageal (white) cuff by removing all of the air with the 20-ml syringe.
  f.  Remove the Combitube™.
  g.  An alternative approach is to deflate both cuffs, remove the Combitube™, and then proceed with tracheal intubation.
6.  To replace the Combitube™ airway when ventilating through the short, clear ventilation tube:
  a.  Preoxygenate the patient.
  b.  Pass a tube-changing stylet through the short, clear tube.
  c.  Deflate both cuffs of the Combitube™ airway and remove the Combitube™.
  d.  Place an appropriately sized endotracheal tube over the stylet and intubate the patient.
7.  To remove the Combitube™ airway in the patient who has regained consciousness or has had return of airway protective or gag reflexes:
  a.  Roll the patient to one side (if possible) and remove all air from both cuffs of the Combitube™ airway.
  b.  Remove the Combitube™ and discard.
  c.  Be prepared to suction the patient as needed.
8.  Discard used supplies, remove gloves, and perform hand hygiene.
9.  Continue to monitor adequacy of airway and ventilations.
10. Document the procedure in the patient's record

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