(The following information comes from the instruction sheet that accompanies the PtL airway. The device is limited to purchase by or on the order of a physician. PtL is a registered trademark of Gettig Pharmaceutical Instrument Co.)
NOTE: This device is for use on adults by specially-trained physicians, nurses, and paramedical personnel. It is not for use by first aid or lay persons. Proper instruction and practice are required prior to use on patients. An adult intubation manikin should be used for training and practice.
CONTRAINDICATIONS:
1. Children - under the age of 14
2. Conscious or semiconscious patients
3. Known caustic poisoning cases
4. Known esophageal disease
Begin artificial ventilation or CPR immediately and verify an open airway. Prepare the PtL Airway to configuration in Figure 1.(BOTH CUFFS SHOULD BE FULLY DEFLATED, WITH A BEND IN THE MIDDLE OF THE #3 LONG CLEAR TUBE.)
If necessary, lubricate the tube with a water soluble lubricant such as K-Y jelly. (DO NOT USE silicone, petroleum jelly, or other oil-base lubricants.)
Insert the PtL Airway quickly between ventilations.
A. INTUBATE PATIENT
Except in cases of suspected C-spine injury, hyperextend the patient's head, then:
Insert your thumb deep into the supine patient's mouth. Grasp the tongue and lower jaw between your thumb and index finger and lift straight upward.
In your other hand, hold the PtL Airway so that it curves in the same direction as the natural curvature of the pharynx. Insert the tip into the mouth and advance it carefully over the tongue until the teeth strap touches the patient's teeth. There will be a modest resistance when making the right angle bend at the back of the oral nasal pharynx. DO NOT USE FORCE If the tube does not advance, either redirect it or withdraw and start over.
Al. SECURE THE NECK STRAP
When the tube is at the proper depth (figure 2, at Lips/teeth), flip the neckstrap over the patient's head. Tighten the hook with tape closures on both sides.
B. INFLATE BOTH CUFFS SIMULTANEOUSLY
With a sustained breath into the #1 Inflation Valve (make sure the white cap is closed), inflate both cuffs. Use cheek pressure to increase the pressure in cuffs to improve seal.
B1. VERIFY TUBE LOCATION
Immediately, blow forcefully into the #2 Short Green Tube.
If the CHEST RISES, the #3 Long Clear tube is in the esophagus. Continue ventilation through the #2 Short Green Tube. (Fig. 2)
If the CHEST DOES NOT RISE, the#3 Long Clear Tube may be in the trachea. Remove the stylet from the #3 Long Clear Tube and ventilate through it. During lung inflation, listen to both sides of the chest and over the stomach with a stethoscope. Verify chest rise with each breath, especially if the #3 Tube is in the trachea of a small young female.
C. VENTILATE LUNGS
Continue ventilation with mouth-to-tube, bag valve, or manually triggered oxygen ventilator.
C1. DECOMPRESS/EVACUATE STOMACH
Place an 18 French Levine suction catheter into the non airway tube (either #3 or #2 tube) to decompress stomach and reduce the possibility of aspiration. Remove the stylet only to pass the catheter through the #3 Long Clear Tube. Catheters can be passed to suction the stomach, oral cavity, or bronchial tree. If no suctioning is performed do not remove the stylet from the #3 tube. If you have verified the proper tube for ventilation, but still seem to be losing air, identify leakage points as (a) Nose; b) Mouth; or (c) Non-airway tube. To reduce leakage, increase cuff pressure by blowing forcefully into the #1 Inflation Valve. You may also use a squeeze bag or demand valve to achieve higher pressures in the cuffs. Tighten the strap better initially, or reposition the PtL Airway to make sure the teeth strap is up against the patient's teeth to further reduce leakage.
REPLACING AIRWAY WITH AN ENDOTRACHEAL TUBE:
FIRST, PASS A LEVINE TUBE AND APPLY SUCTION TO VERIFY THAT THE STOMACH HAS BEEN DECOMPRESSED.
1. TO PASS AN ENDOTRACHEAL TUBE WHILE VENTILATING THROUGH THE #2 SHORT GREEN TUBE:
Pinch the pilot balloon inflation line with the plastic slide clamp; open the white cap on the #1 Inflation Valve. The large oral cuff will deflate to atmospheric pressure and may be deflated further by orally sucking air out through the uncapped port of the #1 Inflation Valve. Insert laryngoscope and quickly intubate the trachea around the PtL Airway, or
2. Deflate cuffs by opening the white cap on #1 Inflation valve. Remove the PtL Airway and intubate patient; or
3. IF THE #3 LONG CLEAR TUBE IS IN THE TRACHEA, you may pass a tube-changing stylet. Deflate cuffs and replace the PtL Airway with an ET tube.
IMMEDIATELY REMOVE THE PtL AIRWAY if the victim regains consciousness or protective airway gag reflexes return. Turn the victim on his/her side and make sure the stomach has been decompressed and gastric contents have been evacuated. Open the white port cap on the #1 Inflation Valve to debate both cuffs. Pull the PtL Airway out and discard. Continue to inspect the patient for adequate ventilation.
CAUTION:
1. NO RESPONSE - IF A PATIENT DOES NOT SEEM TO BE RESPONDING TD THE PtL AIRWAY, OR A QUESTION OF EFFECTIVENESS EXISTS, REMOVE THE PtL AIRWAY AND TRY A DIFFERENT AIRWAY DEVICE. FAILURE TO PROVIDE AN ADEQUATE AIRWAY MAY RESULT IN SEVERE INJURY OR DEATH.
2 . FACIAL TRAUMA OR FACIAL BURNS - Observe chest rise and monitor breath sounds. Facial trauma/burns may cause internal tissue edema, which may gradually obstruct the patient's airway. Replace with an ET tube as soon as possible.
3. POSSIBLE LEAKS:
a. CUFF TEARING - The PtL Airway cuffs may tear when used in patients with severe mouth trauma or with extensive metal dental work. Incidence can be as high as 10 percent. Before inserting the PtL Airway, inspect the victim's mouth and remove any objects (including dentures) that may damage the cuff. Massive leakage may indicate that a cuff, most likely a 1arge one, has been torn. Quickly remove the airway and replace with a new Ptl or other airway.
b. RAPID CUFF LEAKS - Rapid deflation of the cuffs may also be due to accidental opening of the white port cap on the inflation valve. Frequently verify that the white port cap is securely closed. If it is open, both cuffs have been deflated. Close the cap and reinflate the cuffs with a sustained breath into the #1 Inflation Valve.
c. SLOW LEAKS - Frequently inspect the Oral Cuff and the Pilot Balloon for slow leaks. If a slow leak occurs, reinflate cuffs through the #1 Inflation Valve, or replace airway.
d. Improper tightening of the neck strap may result in leakage around the oral cuff.
4. ASPIRATION - Patients who have received basic CPR or who have just eaten are candidates for aspiration (forceful or silent). Immediately decompress the stomach during ventilation. The PtL Airway may not completely seal the esophagus. The rescuer should continue to monitor the upper airway for signs of vomitus passing around the lower cuff. If noted, the upper airway should be suctioned to prevent potential aspiration which can lead to lung injury and death. The normal evacuation path for vomitus from the stomach is through the #3 tube.
NOTES:
1. WHEN YOU REMOVE THE AIRWAY, USE SPECIAL PRECAUTIONS to prevent regurgitation/aspiration.
2. DO NOT DEFLATE CUFFS OR REMOVE THE PtL AIRWAY UNTIL:
(a) Patient has spontaneous and effective respiration and a return of gag and swallowing reflexes, or
(b) An endotracheal tube has been inserted and its cuff inflated in the trachea, and
(c) The stomach has been decompressed via suction through a Levine tube, and
(d) Patient has been turned on his side and there is an effective suction device ready in case of regurgitation.
3. BE SURE TO DEFLATE CUFFS BEFORE REMOVING THE PtL AIRWAY.
Since the PtL Airway uses a soft vinyl cuff to obtain a quality seal, improper use or storage can damage the cuffs. The user must determine the SUITABILITY OF THE TUBE FOR USE before it is put into service.
Note: Single patient use. Device is not to be cleaned and reused because cuffs and inflation valve will be harmed.
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