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EZ-Blocker ®

EZ-Blocker ®. Jan. 2010. EZ-Blocker ®. A bronchoscope is mandatory Bronchoscopic control for all in-, and deflations. EZ-Blocker ®. ETT Endotracheal tube EZB EZ-Blocker ® DLT Double Lumen Tube MPA Multiport Adaptor. Preparations. Preparations. Sterile cloth ETT

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EZ-Blocker ®

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  1. EZ-Blocker® Jan. 2010

  2. EZ-Blocker® • A bronchoscope is mandatory • Bronchoscopic control for all in-, and deflations

  3. EZ-Blocker® • ETT Endotracheal tube • EZB EZ-Blocker® • DLT Double Lumen Tube • MPA Multiport Adaptor

  4. Preparations

  5. Preparations • Sterile cloth • ETT • Lubricant • Syringe • Marker • EZ-Blocker® set • EZB • Multiport Adaptor • Closing caps • CPAP connection piece

  6. Preparations • Inspect for damage • Remove protection shaft of the EZB carefully by pulling the label at the top of the shaft Fix 2 blue closing caps on CPAP ports • Inflate cuffs to check for leakage • Deflate completely  vacuum • Lubricate

  7. Preparations (*)

  8. Preparations • Compare the lengths of EZB withETT plus MPA,place mark on the proximal shaft or remember distance in cm’s • The EZB should wedge on the carina within 8 cm from this mark (*). 4 cm towards the carina and 4 cm to wedge upon the carina

  9. Intubation

  10. Intubation • ETT cuff directly behind the vocal cords • ETT tip to carina at least 4 cm • Connect MPA to ETT and start ventilating through MPA Approx. 100% O2

  11. Intubation EZBextensions need 4 cm to spread before wedging the carina Distal end ETT 4 cm Carina

  12. EZB placement (*)

  13. EZB placement • First action after intubation  Check by bronchoscope for abnormalities in anatomy • Confirm: depth of ETT (4 cm to carina) • Insert EZB through MPA • Check under vision closing main stem bronchus and/or RUL -> if necessary manipulate cuff in right position

  14. EZB placement • Fiberscopic inspection of cuffs • Inflate the cuff in thetarget bronchus until Minimum Occlusive Volume (MOV) has been reached • Deflate the cuff  vacuum

  15. EZB Procedurelung collapse • Ventilate with deflated cuffs. Approx. 100% O2 • Position the patient • Disconnect ventilation from MPA as soon as the surgeon enters the thoracic cavity • Lung will collapse

  16. EZB Procedurelung collapse • If needed, the surgeon manipulates the lung to the size of his desire • After successful collapse, the cuff is inflated under vision, start One Lung Ventilation • Through resorption lung collapse will improve • If collapsed lung starts ventilating again, deflate cuff and disconnect ventilation -> re-collapse! • When lung has the right size -> re-inflate cuff and restart ventilation -> Always check with scope!

  17. EZB removal • End of operation  deflate cuff. Vacuum! • Ventilate carefully to remove all atelectases • Block the other lung for bi-lateral procedure, or remove the EZB • The same ETT is used postoperatively

  18. Essentials

  19. Essentials • ETT cuff must be introduced directly behind the vocal cords

  20. Essentials First action after intubation  Bronchoscopy Confirm: Depth of ETT (4 cm from carina) and location of right upper lobe If a cuff is not inflated, it should be deflated completely (vacuum) Both cuffs should never be inflated at the same time  †

  21. Essentials • After the EZB extends from the ETT, the EZB will wedge on the carina within ± 8 cm • After wedging the EZB on the carina, the ETT may be advanced a few cm for even more stability • No wedge?  Both extensions situated in the same bronchus  Check with scope, retry and/or withdraw ETT for a few cm to provide space for spreading

  22. Essentials ALWAYS withdraw your scope first After that remove the EZ-Blocker NEVER withdraw the EZ-Blocker first

  23. Essentials • Deflate cuffs completely (vacuum) • Carefully ventilate until all atelectases are gone • PEEP is needed before wound closure • Check lung expansion • Remove Bronchoscope first, then the EZB • Never jet-ventilate a patient with a EZB in place -> The lung could be damaged

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