Okay, today we're going to teach you about the double lumen tube. Because in lung surgery, we do not want to inflate or ventilate the lung that is being operated on. So we need to come up with a way to ventilate the non-operative lung while leaving the operative lung down.
So one way to do that is through use of a double lumen tube. It has two ventilation lumens. One lumen for the left lung. and one lumen for the right lung.
So let's check out a diagram to better understand how this works. So this diagram here depicts what a double lumen tube looks like inside of a patient. And what you're going to notice here is that you've got one ventilation lumen that sits in a bronchus, and then you've got another ventilation lumen that sits up here in the trachea. And this is what the actual double lumen tube would look like inside of the patient.
The lumen. Sitting in the bronchus is called the bronchiolumen. The bronchiolumen is the lumen with the blue cuff. And if you come up here to the very top here, you can see that this is the bronchiolumen.
And you can see that ventilation through this lumen will go all the way down into the bronchus. The lumen sitting in the trachea right here is called the tracheolumen. And the tracheal lumen is the lumen with the clear cuff.
And if you come up here to the top again, you can see that this clear lumen is the tracheal lumen. And ventilation through this lumen will ventilate the patient through this port here in the trachea. And so you can see here that in this diagram, ventilation through the tracheal lumen will inflate the right lung.
And ventilation through the bronchial lumen will inflate the left lung. Most double lumen tubes are what we call left double lumen tubes. A left double lumen tube means that the bronchiolumen is designed to go into the left main stem bronchus.
This is depicting a left double lumen tube. A properly placed left double lumen tube allows ventilation to the left lung through the bronchiolumen here, and it allows ventilation to the right lung through the tracheolumen up here. It is important to know that you can place a left double lumen tube down into the right main stem bronchus like this.
Although it's possible to do this, we don't choose to do this because the right lung over here has three lobes, and this right upper lobe right here would be hard to ventilate if the bronchiolumen were placed in the right main stem. So because of this... right upper lobe right here, the vast majority of the time we choose a left double lumen tube and place the bronchial lumen into the left main stem bronchus.
Now, on rare occasions, like if there's a left main stem mass or we're doing a left lung transplant or something like that, we actually do have to place this bronchial lumen into the right main stem. When doing this, we should use a right double lumen tube. Now the only difference between a left double lumen tube and a right double lumen tube is that this is a right double lumen tube.
The right double lumen tube has this extra ventilation port here that is designed to ventilate this right upper lobe. And you can see here on the left double lumen tube, it does not have that extra ventilation port. Okay, the materials that you're going to need before double lumen tube placement You're going to need the actual double lumen tube itself.
The next thing that you're going to need is a specialized adapter that's going to allow you to ventilate both lungs. Because you see here, I'm not going to be able to ventilate both lungs at the same time. So we have this specialized adapter that fits on just like this, and then you are able to ventilate both lungs. One thing you're going to notice about this adapter is that they have these specialized caps. that open the lungs to the atmosphere.
And those caps also allow passage of things like a fiber optic bronchoscope. or a suction catheter. So that's what this is for.
This is your suction catheter that you're going to be able to use. The next thing that you're going to need is a large hemostat to be able to isolate a lung. The last thing that you're going to need is a stylet to help you place this, and just know that the stylet always goes through the bronchial lumen.
So if I were to isolate this right lung, I would clamp the double lumen tube proximal to the cap. You cannot clamp it distal to the cap because you're going to want to be... be able to open up the cap to atmospheric air because that's what's going to allow the lung to deflate. So sometimes the lung deflation is going to be a little bit slow and the surgeon is going to ask you to apply suction to the lung.
So that's where this suction catheter comes in. Another option that you have with lung deflation that actually makes it go faster is you can actually once this is clamped rather than opening the cap here you can simply just disconnect it right there at the connector and that way the lung will deflate faster and you can apply suction by just placing the tubing directly up to the connector there and your lung will deflate much faster. The one thing that I want to say about suctioning the lung is you never want to leave suction connected to the lung because you'll get major atelectasis over time.
You only want to hook up suction to a lung initially to get the lung deflated.