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Policies,Clinical,UWHC Clinical,Department Specific,Emergency Department

The Management or Exchange of a Supraglottic Airway Device (31.2)

The Management or Exchange of a Supraglottic Airway Device (31.2) - Policies, Clinical, UWHC Clinical, Department Specific, Emergency Department

31.2







Effective Date:
8/12/2015

Administrative Manual
Nursing Manual (Red)
X Other Emergency
Department

Policy #: _31.2_____

Original
xX Revision

Page
1
of 3


Title: The Management or Exchange of a
Supraglottic Airway Device—CSC ED

I. PURPOSE

To define a process for the management or exchange of a supraglottic airway device for
patients arriving to the Emergency Department (ED) via ground or air transport.

II. GUIDELINE

A. General considerations for supraglottic airway devices
1. Considered to be an ‘unsecured’ airway (not a definitive airway)
2. It is recommended that they be replaced with a definitive airway within two
hours of placement if there is evidence of tongue engorgement
3. A patient going directly to the operating room (OR) from the ED does not need
to have the supraglottic airway device replaced if it is functioning proper.

III. Steps to determine if the supraglottic airway device is working properly
A. Ventilation criteria
1. Using a manual resuscitation bag, tidal volume breaths should flow easily into
the lungs with bilateral chest rise and no significant air leak around the device.
2. Breath sounds are audible with each breath
3. Evidence of appropriate EtCO2 waveform, indicating appropriate gas exchange
and ventilation
B. Oxygenation criteria
1. Pulse oximetry shows an SaO2 > 92%
C. Contact anesthesia at provider discretion for routine airway device exchange if above
criteria for ventilation and oxygenation have been met.

IV. Procedures if supraglottic airway device is not functioning properly

A. Ventilation problems
1. Difficulty bagging or delivering tidal volume ventilations through airway device
a. Check ventilation circuit- ensure it is connected and not obstructed/ kinked
in airway
b. Suction supralaryngeal airway
i. Suction the gastric port when present (King LTS-D) with a
separate suction catheter.
ii. Check the device position.






Effective Date:
8/12/2015

Administrative Manual

X Other Emergency
Department

Policy #: _31.2_____

Original
xX Revision

Page
2
of 3


Title: The Management or Exchange of a
Supraglottic Airway Device—CSC ED


ξ Make slight adjustments (withdraw, rotate or insert) while
attempting ventilation.
ξ If ventilation improves, secure device in new position.
ξ Contact anesthesia for airway device exchange if
ventilation and oxygenation criteria are achieved.
2. Large air leak around supraglottic airway
a. Check for dislodgement of airway device and reposition if appropriate.
i. King LT is placed correctly if the colored connector is aligned with
the teeth/ gums.
b. Check balloon pressure
i. Supraglottic airway balloon should be inflated with the appropriate
volume of air according to manufacturer recommendations (noted
on indicator balloon).
B. Oxygenation problems
1. Increase FiO2 or PEEP if available
2. Check for sources of hypoxia and correct
C. Contact anesthesia for airway device exchange if above criteria for ventilation and
oxygenation have been met.
D. If above steps have failed to correct oxygenation and ventilation, use emergency paging
system to call for anesthesia and surgical back up.
1. Gather equipment and prepare for difficult airway management
2. Suction gastric port if present
3. Perform rapid sequence intubation (RSI)
a. Delfate supraglottic airwy device duff and perform direct layngoscopy
(DL) or videolaryngoscopy (Glidescope) intubation around the device if
left in place or de novo if removed.

V. REFERENCES
1. Mayglothling J, Duane TM, Gibbs M, et al. Emergency tracheal intubation
immediately following traumatic injury: an Eastern Association for the Surgery
of Trauma practice management guideline. J Trauma Acute Care Surg.
2012;73(5 Suppl 4):S333-40.

2. Timmermann A. Supraglottic airways in difficult airway management:
successes, failures, use and misuse. Anaesthesia. 2011;66 Suppl 2:45-56.









Effective Date:
8/12/2015

Administrative Manual

X Other Emergency
Department

Policy #: _31.2_____

Original
xX Revision

Page
3
of 3


Title: The Management or Exchange of a
Supraglottic Airway Device—CSC ED




VI. REVIEWED BY

Medical Director, Emergency Department
Nurse Manager, Emergency Department
Director, Emergency Services
Division Chief, Emergency Services
Emergency Department Clinical Operations Committee



SIGNED BY
Jeff Pothof, MD
Vice Chair of Quality and Operations
Department of Emergency Medicine

Brian Sharp, MD
Medical Director
Emergency Department
The American Center

Tami Morin, MS, RN
Director
Emergency Services