I-gel Airway Insertion Overview

Hey guys, my name is Sam and welcome to PrepMedic. This week's video I'm going to show you how to insert an i-gel airway. So the i-gel is a superglottic airway which means it sits above the glottis. Now its sole purpose is to facilitate ventilation down into the lungs. As we all know if you've ever tried to do a mask seal and do bag valve mass respirations this takes at least two people and is very imprecise. where this airway allows us to get a little bit deeper and create a seal with only one person and very minimal effort. So my team inserts eye gels as a primary airway for cardiac arrest simply because it can be inserted in five seconds and then frees us up to do other tasks such as good compressions, pushing medications, or getting a history on the patient depending on how many people we have around us. We also use it as a rescue airway if endotracheal intubation has failed. Now, when this is inserted, the tip right here sits in the esophagus, and the rest of this sits on the airway anatomy, and allows us to ventilate directly into the trachea, and hence, the lungs. Now, the reason I say it offers some airway protection is because this does occlude the esophagus to a point, but it is not considered a definitive airway, and it's not going to protect this patient from massive amounts of fluid, vomit, you name it. So it's not going to stop aspiration. entirely and the manufacturers will tell you it's not meant for that at all. Now sizing the eye gel is relatively complicated even though it seems simple and this is one of the things I don't understand with this device. So we've got a lot of different sizes ranging from I think it goes one, two, three, four, and five. The most common size you're going to use is a number four and you're going to notice on all these eye gels and all the packaging you actually have weights on it. Now this is not the patient's actual weight. This is their ideal. body weight. So when we are calculating ideal body weight this is where things get a little bit confusing. For a male it is 50 plus 2.3 inches for every inch over 5 feet. So if the patient is 5 foot 1 they're going to be 52.3 kilograms of ideal body weight. Now for a female it's 45.5 plus 2.3 for every inch over 5 feet. And that's how we're going to size these. Now, that is relatively confusing on why we're using ideal body weight when ideal body weight is a measurement totally gained off of height. That's the only number you need to calculate it. So I don't know why the manufacturer here didn't just put their height for the sizing. As it stands, we do have to use ideal body weight. What I will tell you is that fives will fit for large adults, fours will fit for normal size adults, and then it goes on down the line. there and it's really easy to switch out sizes if you get it a little bit wrong. But just know the ideal body weight measurement for them. So the insertion of these is really simple, but we need a couple things prepped before we do it. We basically have to set up for intubation. So I would recommend having suction on hand, ready, turned on, and clearing that oropharynx before we begin. The next thing we need is some kind of bag valve mask. So right here I've got micro BVM. I'm going to take this out. and get this ready for the patient. Now probably if we're inserting this we already have rescue breaths started. So we're going to make sure somebody is ventilating this patient, they can have an OPA MPA in place, we just have to make sure we take those out before we attempt insertion of an eye gel. I'm going to have the eye gel out now they come in this cradle here. We're going to take it out of the packaging, keep it in the cradle, and just have this readily accessible. And I'm also going to have a size up and a size down. just in case this doesn't work. If I'm using this as a primary airway, I might have to consider what I'm doing as a secondary or tertiary airway down the road. I'm going to get out my capnography device, so this is going to be what confirms placement. Now, this does not have the same risk as endotracheal intubation. I'm not worried about inserting this airway necessarily into the esophagus when it's supposed to be, you know, through the cords in the trachea, but we still need to confirm placement because things can still go wrong. So I have my capnography device, booting up and ready to go there. When I have all of that set, I'm going to get ready for insertion. So first thing I'm going to do is I'm going to suction the oropharynx. This is just going to make sure things are cleared out and it gives this the best chance to work. When this comes out, you're going to see a little dimple on the case. Now, I'll be honest, I've never actually used that dimple there. That's for lubricant. You can take your medical lubricant. Now for this dummy, I'm using just Purell because it doesn't gum up the airway. You put some in that dimple right there and then we can take this eye gel. We want to lubricate the tip here, the sides, and then the back. And you can be pretty liberal with that. We just don't want to get the lubricant right here because that's going to not facilitate insertion. And just for this mannequin, because it's hard plastic, there's no... Such thing as saliva, we're gonna kind of give a little bit more in the airway. Next thing we're going to do is we're gonna make sure the patient's mouth is open. We don't want to reach into the patient's mouth for any reason and I'm going to start inserting it with the tip being pushed up to the hard palate. As I insert, I don't want to just be inserting right down because that's gonna get the tongue, so I'm going to insert it in the back kind of with that upward pressure and I'm gonna go down until it gets, until I get like meaningful resistance. So I go down, I've got meaningful resistance. and you're going to notice at the top of the eye gel there's a hard bite block. So they're not going to bite through that block if they do develop some trismus and clamp down. It's not going to actually affect your airway. Once that's in place, I'm going to take my capnography device, put it in place. I'm going to take my bag right here, and I'm going to hold on to that, and I'm going to respirate. Now, on this dummy, I do have a little bit of lung inflation, but its airway isn't very good. Here, I'm going to ventilate. Roughly one time every six seconds. I'm going to listen to both the lungs and I'm going to listen to the epigastrium to make sure it is in the right place. The next step is going to be securing this. So some of these have a bracket and a strap that can secure it in place. You can just hold it in place or if you have a Thomas II tamer, they make one that's a little bit wider to accommodate the eye gel. It will hold it there. The last thing I want is to get distracted and pull this out of their mouth. If I don't have a securing device in place, I just need to make sure one hand is over the tube. at all times. Now when we're squeezing the bag we want to make sure we're only squeezing the bag until I see chest rise. I don't need to get all the air out of this bag because this thing has a volume of about a thousand milliliters when the average tidal volume of a patient is only about 500 milliliters. So it's got twice the air I need in it. It's just a really light squeeze until I see that chest rise and then I'm stopping. Now some failure points on the eye gel. What I've seen most often and what causes me to go to an endotracheal intubation in these patients is copious amounts of secretions coming out of the eye gel or copious amounts of vomit. That has usually been what has stopped me from getting it. If we don't have a good capnography reading, if we have a lot of secretions there, if I don't have good compliance in the lungs, it might be time to go to a more definitive airway. When we're pulling this out, it comes out basically the same way it comes in. We can just pull it out just like this. There's nothing to inflate on this whatsoever, so I don't need to deflate a balloon. Now one of the big myths with these is that these will actually like start taking on heat from the body and form a seal after the patient's heat heats it up. That's totally a myth. The manufacturer's totally debunked that. These will work even if they're a little bit chilly and it doesn't rely on heat at all. So this intervention can be performed by a wide range of responders. In many states even EMRs can do it. If you have any questions leave them in the comments down below and I will see you next week.

where this airway allows us to get a little bit deeper and create a seal with only one person and very minimal effort. So my team inserts eye gels as a primary airway for cardiac arrest simply because it can be inserted in five seconds and then frees us up to do other tasks such as good compressions, pushing medications, or getting a history on the patient depending on how many people we have around us. We also use it as a rescue airway if endotracheal intubation has failed.

Now, when this is inserted, the tip right here sits in the esophagus, and the rest of this sits on the airway anatomy, and allows us to ventilate directly into the trachea, and hence, the lungs. Now, the reason I say it offers some airway protection is because this does occlude the esophagus to a point, but it is not considered a definitive airway, and it's not going to protect this patient from massive amounts of fluid, vomit, you name it. So it's not going to stop aspiration.

entirely and the manufacturers will tell you it's not meant for that at all. Now sizing the eye gel is relatively complicated even though it seems simple and this is one of the things I don't understand with this device. So we've got a lot of different sizes ranging from I think it goes one, two, three, four, and five.

The most common size you're going to use is a number four and you're going to notice on all these eye gels and all the packaging you actually have weights on it. Now this is not the patient's actual weight. This is their ideal.

body weight. So when we are calculating ideal body weight this is where things get a little bit confusing. For a male it is 50 plus 2.3 inches for every inch over 5 feet.

So if the patient is 5 foot 1 they're going to be 52.3 kilograms of ideal body weight. Now for a female it's 45.5 plus 2.3 for every inch over 5 feet. And that's how we're going to size these. Now, that is relatively confusing on why we're using ideal body weight when ideal body weight is a measurement totally gained off of height.

That's the only number you need to calculate it. So I don't know why the manufacturer here didn't just put their height for the sizing. As it stands, we do have to use ideal body weight.

What I will tell you is that fives will fit for large adults, fours will fit for normal size adults, and then it goes on down the line. there and it's really easy to switch out sizes if you get it a little bit wrong. But just know the ideal body weight measurement for them. So the insertion of these is really simple, but we need a couple things prepped before we do it.

We basically have to set up for intubation. So I would recommend having suction on hand, ready, turned on, and clearing that oropharynx before we begin. The next thing we need is some kind of bag valve mask. So right here I've got micro BVM. I'm going to take this out.

and get this ready for the patient. Now probably if we're inserting this we already have rescue breaths started. So we're going to make sure somebody is ventilating this patient, they can have an OPA MPA in place, we just have to make sure we take those out before we attempt insertion of an eye gel. I'm going to have the eye gel out now they come in this cradle here.

We're going to take it out of the packaging, keep it in the cradle, and just have this readily accessible. And I'm also going to have a size up and a size down. just in case this doesn't work. If I'm using this as a primary airway, I might have to consider what I'm doing as a secondary or tertiary airway down the road. I'm going to get out my capnography device, so this is going to be what confirms placement.

Now, this does not have the same risk as endotracheal intubation. I'm not worried about inserting this airway necessarily into the esophagus when it's supposed to be, you know, through the cords in the trachea, but we still need to confirm placement because things can still go wrong. So I have my capnography device, booting up and ready to go there.

When I have all of that set, I'm going to get ready for insertion. So first thing I'm going to do is I'm going to suction the oropharynx. This is just going to make sure things are cleared out and it gives this the best chance to work.

When this comes out, you're going to see a little dimple on the case. Now, I'll be honest, I've never actually used that dimple there. That's for lubricant.

You can take your medical lubricant. Now for this dummy, I'm using just Purell because it doesn't gum up the airway. You put some in that dimple right there and then we can take this eye gel. We want to lubricate the tip here, the sides, and then the back. And you can be pretty liberal with that.

We just don't want to get the lubricant right here because that's going to not facilitate insertion. And just for this mannequin, because it's hard plastic, there's no... Such thing as saliva, we're gonna kind of give a little bit more in the airway.

Next thing we're going to do is we're gonna make sure the patient's mouth is open. We don't want to reach into the patient's mouth for any reason and I'm going to start inserting it with the tip being pushed up to the hard palate. As I insert, I don't want to just be inserting right down because that's gonna get the tongue, so I'm going to insert it in the back kind of with that upward pressure and I'm gonna go down until it gets, until I get like meaningful resistance.

So I go down, I've got meaningful resistance. and you're going to notice at the top of the eye gel there's a hard bite block. So they're not going to bite through that block if they do develop some trismus and clamp down.

It's not going to actually affect your airway. Once that's in place, I'm going to take my capnography device, put it in place. I'm going to take my bag right here, and I'm going to hold on to that, and I'm going to respirate.

Now, on this dummy, I do have a little bit of lung inflation, but its airway isn't very good. Here, I'm going to ventilate. Roughly one time every six seconds. I'm going to listen to both the lungs and I'm going to listen to the epigastrium to make sure it is in the right place. The next step is going to be securing this.

So some of these have a bracket and a strap that can secure it in place. You can just hold it in place or if you have a Thomas II tamer, they make one that's a little bit wider to accommodate the eye gel. It will hold it there. The last thing I want is to get distracted and pull this out of their mouth.

If I don't have a securing device in place, I just need to make sure one hand is over the tube. at all times. Now when we're squeezing the bag we want to make sure we're only squeezing the bag until I see chest rise. I don't need to get all the air out of this bag because this thing has a volume of about a thousand milliliters when the average tidal volume of a patient is only about 500 milliliters. So it's got twice the air I need in it.

It's just a really light squeeze until I see that chest rise and then I'm stopping. Now some failure points on the eye gel. What I've seen most often and what causes me to go to an endotracheal intubation in these patients is copious amounts of secretions coming out of the eye gel or copious amounts of vomit.

That has usually been what has stopped me from getting it. If we don't have a good capnography reading, if we have a lot of secretions there, if I don't have good compliance in the lungs, it might be time to go to a more definitive airway. When we're pulling this out, it comes out basically the same way it comes in. We can just pull it out just like this. There's nothing to inflate on this whatsoever, so I don't need to deflate a balloon.

Now one of the big myths with these is that these will actually like start taking on heat from the body and form a seal after the patient's heat heats it up. That's totally a myth. The manufacturer's totally debunked that.

These will work even if they're a little bit chilly and it doesn't rely on heat at all. So this intervention can be performed by a wide range of responders. In many states even EMRs can do it. If you have any questions leave them in the comments down below and I will see you next week.

Transcript for:I-gel Airway Insertion Overview

Transcript for:
I-gel Airway Insertion Overview