Double Lumen Tubes
tl;dr
- 39 for men, 37 for women
- left sided to use, twist anticlockwise (take stylet out after cords)
- confirm in right place by scope down tracheal, see bronchial in left, go into right upper and see 3 bronchioles
- if in emergency by yourself, just use uncut single lumen, plus ambuscope to focus on desired lung
Why might I need a double lumen tube (in ICU not theatres)
- Thoracic trauma
- Thoracic bleeding
- Bronchopleural fistula?
However what might I really do in an emergency?
- Place a single lumen uncut
- Place a scope and advance it into lung I want
Sizing
- Is in french scale, go for roughly
Insertion
- Use the stylet
- Check both cuffs
- Pass tube beyond cord and take stylet out
- Twist anti clockwise with the left sided tubes, keep going until resistance
Confirming placement
- Scope down trachea
- See carina,
- Go into right and right upper to show you aren't down too far and seeing a false carina
- See bronchial cuff in left main bronchus
- Inflate bronchial cuff,
- See not herniating
Troubleshooting
- If hypoxic and one lung ventilating, see if can go back to two lungs
- Increase FiO2 to 1
- Confirm positioning again with scope
- Fix haemodynamics
- Can do recruitment, this will make haemodynamics worse
- Can insufflate non ventilated lung sometimes
- Lung protective ventilation is the same (although remember that you will need to halve your volume targets)
Source
- 2021/08/21 - Teaching session in theatre - Mark Thornton