Abstract

In patients requiring an intra-operative airway exchange, does the use of a CAEC allow for safer, more effective airway exchange compared to a GEB?

One of the biggest benefits of the CAEC is its ability to provide oxygenation to the patient throughout the ETT exchange via jet ventilation. However, this oxygen and pressure can create a one-way valve, resulting in a pneumothorax and potentially leading to cardiovascular collapse. The rate of pneumothorax with a CAEC is up to 11%. In order to prevent this, CAECs with jet ventilation should not be used with patients who are at an increased risk for a pneumothorax or those who would not be able to tolerate this complication. Additionally, if a CAEC passes through the Murphy's eye of the ETT it can cause tracheal laceration, perforation, or pneumothorax. Overall failure of ETT exchange with CAECs is 13.8%.

Complications also exist with GEBs and are most often seen with aggressive or blind placement. In fact, only 0.8 Newton power can result in airway trauma. Complications seen with GEBs include tracheal injury, bleeding, abrasions, perforations, pneumothoraxes, and tracheal rupture. Lubrication should be applied to the GEB, and it should be advanced slowly to mitigate these complications. Additionally, the angled tip of the GEB should face anteriorly and it should not be advanced past 22 cm past the incisors. One of the biggest problems with using a GEB is its length relative to the ETT. When removing the ETT, the length of the GEB can become lost in the ETT and oral cavity, causing the anesthetist to lose control of the GEB. In order to solve this problem, the in situ and new ETT can be cut to 24-26 cm to allow continuous control over the GEB.

Author Details

Catherine Kinney, BSN and Lauren Barnes, DNP, CRNA

Sigma Membership

Theta Delta

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Other

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Airway Exchange, Endotracheal Tube, Cook Airway Exchange Catheter

Advisor

Barnes, Lauren

Degree

DNP

Degree Grantor

Samford University

Degree Year

2023

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2023-02-17

Full Text of Presentation

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