Clinical Practice Procedures: Airway management/Intubating

Clinical Practice Procedures:
Airway management/Intubating catheter (bougie)
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Date
October, 2015
Purpose
To ensure a consistent procedural approach to Intubating catheter (bougie).
Scope
Author
Applies to all QAS clinical staff.
Clinical Quality & Patient Safety Unit, QAS
Review date
October, 2017
URL
https://ambulance.qld.gov.au/clinical.html
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Intubating catheter (bougie)
October, 2015
The Frova Intubating Catheter ( FIC ) is a 70 cm pre-curved 14Fr (4.6mm) airway introducer with a 30° angled distal tip designed to assist with oral
endrotracheal tube placement during routine and difficult intubations.[1−4]
Indications
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The FIC’s narrow diameter and angled tip enables targeted anatomical placement maximising the accuracy of tracheal placement.
• Placement of oral endotracheal tubes with an internal diameter (ID) of ≥ 6 mm
Curved FIC ready for use
Contraindications
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• Nil in this setting
Complications
• Trauma or perforation of the airway structures
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Figure 3.6
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Procedure – Intubating catheter (bougie)
1. Gently extend the curve of the FIC to optimise controlled directional placement.
2. Visualise the the larynx under direct laryngoscopy.
5. Gently advance the FIC into the trachea. If resistance is felt, do not force advancement but rather gently rotate the FIC anti-clockwise before reattempting
advancement.
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3. With the right hand grasp the FIC with a ‘pen like’ grip whilst maintaining laryngoscopy.
6. The ‘clicking’ of the tracheal rings or ‘hold up’ when the FIC contacts the carina may be identified and is an indicator of correct tracheal placement.
7. Whilst maintaining visualisation of the larynx, have an assistant ‘railroad’ the endotracheal tube over the FIC into the correct anatomical position.
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e
Additional information
• Length markings are listed on the internal curvature of the FIC outlining depth and orientation of the distal tip.
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• Although traditionally designed to assist with
Cormack-Lehane grade III and IV views, the bougie is considered mandatory for all adult
patient intubations by QAS paramedics.
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4. Gently insert the upturned distal tip of the FIC under the epiglottis and advance midline towards the glottis.
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