Re: Thoughts about Combitubes. Originally Posted by cotjockey Tracheal placement is rare...in almost eight years in EMS, I have never seen a tracheal placement and no one in my paramedic class ever admitted to seeing one. I don't remember for sure, but I believe the distal end of the Combitube is more like an 8 or maybe a 9...there are guidelines about what size of people they can be used with (there are pediatric Combitubes, but I've never seen one). According to the anesthesiologist that taught our airway classes, most adults can safely tolerate a 9 for a short period. Also, the anesthesiologist said that even though you are usually using a Combitube because you can't get an ET, and you're not going to be able to hit the trachea blind if you can't hit it visualized, best practice would be to use the larygoscope and visualize to ensure an esophageal placement.
I think I confused myself...hope this makes sense!
Although you won't see many tracheal placements, it can happen (that's why the tube is designed the way it is). And the idea that you won't hit it blindly if you can't see it is BS.
Also - the whole idea for this tube is blind placement, with a device DESIGNED to be used whether it's placed in the esophagus or trachea. Placing under direct vision makes little sense to me.
Remember - this is NOT a first-line A/W device - it's designed to be used when you can't get an ETT in or for those who aren't allowed to place ETT's. Unless you have no alternatives, it is NOT a device that should be used with any frequency at all, and if your paramedics are using them a lot after unsuccessful intubations, they need to work on their intubation skills, not continue to resort to an inferior airway device
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