Removal of the laryngeal mask using a cuffed tube

Removal of the laryngeal mask using a cuffed tube

How to remove a laryngeal mask leaving the cuffed endotracheal tube in place

19. August 2015 – 1 Comments

Why do it
Fiberoptic intubation via the laryngeal mask can also be performed using a cuffed endotracheal tube. In this case you should use the technique without the swivel connector. But the removal of the laryngeal mask with the endotracheal tube in place can be somewhat awkward. The valve of the cuffed tube will hinder the passage through the laryngeal mask. You can either use a tube exchanger or use an alternative technique which we demonstrate now.

How to do it
First cut the pilot line which connects the valve and the cuff. Perform fiberoptic intubation via the laryngeal mask and remove the laryngeal mask as usual just as with a non-cuffed tube. Then repair the pilot line using a 24 or 22 gauge plastic venous catheter. Now you can block the tube. Thread the line on the catheter, remove the needle and fix a three-way stop-cock.

How do it right. The fine points
Always cut the pilot line at a slant. That makes threading easier. Threading the pilot line on a venous catheter without perforating takes care and some experience. The longer the distance you thread, the better the bond will be. Once fitted, the connection is very robust. It withstands even high pressures of several atmospheres and the cuff is more likely to burst than this connection.


Andreas Machotta's picture

Another suitable technique to remove the laryngeal mask is using a tube exchanger. Perform fiberoptic intubation via a laryngeal mask with an uncuffed tube as demonstrated on this site and remove of the laryngeal mask together with the tube using a tube exchanger. A cuffed endotracheal tube can now be inserted via the tube exchanger.

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