Jammed ETT Connector...Solutions?

ThadeusJ

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Having a discussion with my esteemed colleagues and would like additional input. Has anyone experienced a jammed ETT (or other device) that was jammed onto the BVM or vent connection so tight that you couldn't separate them and/or use the wedge that may have been supplied?

Any thoughts and or solutions?
 

E tank

Caution: Paralyzing Agent
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Having a discussion with my esteemed colleagues and would like additional input. Has anyone experienced a jammed ETT (or other device) that was jammed onto the BVM or vent connection so tight that you couldn't separate them and/or use the wedge that may have been supplied?

Any thoughts and or solutions?


clamp.jpeg



Two of these and a twist usually is all it takes.
 

E tank

Caution: Paralyzing Agent
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Exactly what I do. If you can misappropriate some ECMO clamps, even better.
Pretty close. These are for a cardiopulmonary bypass circuit. The same clamps, really...Any beefy kelly type clamp works
 

Carlos Danger

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I've seen some jammed together pretty hard a few times, but I don't remember ever not being able to twist them apart after a few tries.

I very recently had the opposite problem. Had just placed an ETT on an already-hypoxemic patient with multiple comorbidities who desaturated precipitously during the quick and easy intubation. I breathed him back up, then when I cut the tube down to shorten it for the bronchoscope, I could not get the connector to re-seat on the ET tube. Several tries. Would not go back on. Sp02 is in the 60's now and falling. Patient is blue. I was seconds away from having to pull the ETT and re-intubate, but I decided to cut the tube again - cleaner and straighter - and the connector went back on after that. I should cut them and re-place the connector before intubation, but I always freakin' forget to until we are ready to go and the pulmonologist is like "you mind shortening that tube a little bit?" I bet I won't forget next time.
 

Brandon O

Puzzled by facies
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I breathed him back up, then when I cut the tube down to shorten it for the bronchoscope
Can you shed some light on this mysterious practice? Last I checked bronchoscopes are longer than endotracheal tubes.
 
OP
ThadeusJ

ThadeusJ

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I bet I won't forget next time.
.
Good judgement comes from experience and experience comes from bad judgement. When we used to pre-cut the tubes, we would do it on an angle, however too much of an angle and the cut would be longer than the actual connector (facepalm). At least you didn't cut the pilot balloon.
 

Carlos Danger

Forum Deputy Chief
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Can you shed some light on this mysterious practice? Last I checked bronchoscopes are longer than endotracheal tubes.
Yes, bronchoscopes are definitely longer than ET tubes. But the straighter the ETT is and the less it moves, the more stable the scope is and the easier it is to drive. The shorter the section of the tube outside the mouth is, the less floppy it is, and the easier it is to hold straight and keep stabilized with your non-dominant hand.
 

E tank

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Yes, bronchoscopes are definitely longer than ET tubes. But the straighter the ETT is and the less it moves, the more stable the scope is and the easier it is to drive. The shorter the section of the tube outside the mouth is, the less floppy it is, and the easier it is to hold straight and keep stabilized with your non-dominant hand.
That and lower lobe segmental bronchi thru an ETT may be a bridge too far in taller dudes for a 50 cm scope. You might could get to 31 cm from the teeth and just be into the left main bronchus. Add the 10 cm of dead space ETT above the teeth and you only have 9 or 10 cm to go deep with if you have to. I'll drop an LMA or Igel if the operator is cool with it to give him a little more distance.
 

Brandon O

Puzzled by facies
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Oy. These give us grief in the ICU sometimes. We run out of room to advance 'em in long patients... or the adaptor (as discussed) gets all weird.
 

VFlutter

Flight Nurse
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Aye, aye...that's why we cut tubes...
I am assuming this is in the bronchoscopy suite or OR? Do you exchange the tube if they are staying intubated in the unit?
 

E tank

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I am assuming this is in the bronchoscopy suite or OR? Do you exchange the tube if they are staying intubated in the unit?
Depends...elective...wake up and go home...ICU....probably intubated and staying put...leave the tube as is...
 

Brandon O

Puzzled by facies
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Depends...elective...wake up and go home...ICU....probably intubated and staying put...leave the tube as is...
We're usually real excited to do a tube exchange in someone who was a difficult enough airway to need a fiberoptic intubation...
 

E tank

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We're usually real excited to do a tube exchange in someone who was a difficult enough airway to need a fiberoptic intubation...
They're pretty fun...we live for that stuff...just give us a page after lunch...we'll be right there.
 

Brandon O

Puzzled by facies
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They're pretty fun...we live for that stuff...just give us a page after lunch...we'll be right there.
(Anesthesia's secret is that it's always lunch)
 

Ridryder911

EMS Guru
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Check with your local RT's and those that work with vents... There are some companies that make BVM's with this neat little device to remove "jammed" ETT from the BVM's or other ventilator type devices.
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