Kiwi grip bougie ET insertion?

NUEMT

NUEMT

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Anyone else doing this for the treacheally challenged?
 
Yep. Been using it for the last year or so. Works as advertised.
 
Regular part of your practice or only in certain cases?
 
It is rad.
 
NUEMT said:
Regular part of your practice or only in certain cases?
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Every tube. I don't intubate much anymore, so I like to stack the deck in my favor. No VL here, but no RSI either, so all my tubes in the last year or so have been dead (or mostly dead) people.

I've also shown most of the other guys the kiwi and some look at me like I'm an alien, but the ones who get it, love it. Takes a lot to get some medics out of their comfort zone.
 
I think as a new person I should just use the bougie every time. I've had no issues intubating "easier" airways without it, but I think it's going to take a fair amount of time to reliably determine who is going to be hard and who is not. Being surprised is not a good feeling...

If only people would stop viewing them as a crutch?
 
The bougie is a great tool, I wish I would have given it more consideration when I was first a medic. My medical director now really likes to see us us them and has shown us tips like the kiwi grip to make managing them a little easier.
 
Sadly our management made us remove the bougies from our main response bags so now they are just kept in the unit. With that being said I still keep one in our response bags
 
DEmedic said:
Every tube. I don't intubate much anymore, so I like to stack the deck in my favor. No VL here, but no RSI either, so all my tubes in the last year or so have been dead (or mostly dead) people.

I've also shown most of the other guys the kiwi and some look at me like I'm an alien, but the ones who get it, love it. Takes a lot to get some medics out of their comfort zone.
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True statement. Stacking the deck in the airway world is super advised. If interested... Check out Scott Weingarts DSI..
 
Good instructional video from an EM attending at GRU. Love watching his videos.
 
Larry Mellick does excellent work on youtube.
 
I didn't realize there was a name for it, but as others have echoed, I use it every time. I don't see why you wouldn't try to make your first attempt your best attempt.
 
What advantage does this offer over the traditional technique of placing the bougie and then sliding the ETT onto it?
 
I guess anything that helps you get the tube in isn't necessarily a bad thing, and anything that optimizes your chances is useful to a point. However, your first attempt is not always your best attempt - sometimes you can't see an anatomical problem until you actually visualize it, and then perhaps make an adjustment so that your 2nd attempt is your best attempt.

What I really like to see with my students is for them to learn how to intubate properly without all the crutches and gimmicks that people keep coming up with. There is a growing concern that many folks, sadly including anesthesia professionals, want to use a VL for every intubation and will lose their basic intubation skills. I agree, and I think that's wrong way to go about doing it. Learn it the right way first before trying to take shortcuts or the easy way out. This video not only uses a VL, but this "kiwi bougie" technique, which is pretty much overkill and takes a lot more time to set up and do. There will be times when you don't have your VL, or your bougie, or you'll use them and they won't be helpful. Hey, I'm a huge fan of our GlideScopes - but they are not the be-all and end-all of intubation aids, and neither are bougies, and neither are bougies with a "kiwi grip".
 
Remi said:
What advantage does this offer over the traditional technique of placing the bougie and then sliding the ETT onto it?
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I feel it gives you a bit more dexterity in manipulation of the distal end of the bougie.

Frankly, I don't intubate enough to be comfortable with multiple attempts at a tube. If I can increase the odds of first pass success, I'm happy. And if I don't have all the tools to place an airway correctly, I'll just place an SGA.

I'm certainly no airway ninja, but watching some of my colleagues attempt intubation makes me look forward to the day when intubation is removed from the standard paramedic scope.
 
jwk said:
I guess anything that helps you get the tube in isn't necessarily a bad thing, and anything that optimizes your chances is useful to a point. However, your first attempt is not always your best attempt - sometimes you can't see an anatomical problem until you actually visualize it, and then perhaps make an adjustment so that your 2nd attempt is your best attempt.

What I really like to see with my students is for them to learn how to intubate properly without all the crutches and gimmicks that people keep coming up with. There is a growing concern that many folks, sadly including anesthesia professionals, want to use a VL for every intubation and will lose their basic intubation skills. I agree, and I think that's wrong way to go about doing it. Learn it the right way first before trying to take shortcuts or the easy way out. This video not only uses a VL, but this "kiwi bougie" technique, which is pretty much overkill and takes a lot more time to set up and do. There will be times when you don't have your VL, or your bougie, or you'll use them and they won't be helpful. Hey, I'm a huge fan of our GlideScopes - but they are not the be-all and end-all of intubation aids, and neither are bougies, and neither are bougies with a "kiwi grip".
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I agree, anything that makes you more likely to be successful is a good thing. I just don't see how this fancy way to hold the bougie and ETT together is any kind of an improvement.

The VL thing is interesting. Personally, I completely agree with you. On the other hand, some argue that eventually laryngoscopes won't even exist. The thinking is that VL is simply "better" than DL and as the tech improves, there will never be reason to use DL. Not unlike the way that CL's are now placed exclusively under US, whereas just 10 years ago US was seen by many as just a novelty for that purpose.

I was trained to do PNB's 100% with US.......I could probably manage an axillary by landmark, but that'd be it, considering the landmarks for some of the blocks are different when you are relying solely on paresthesia or twitches.
 
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Remi said:
I agree, anything that makes you more likely to be successful is a good thing. I just don't see how this fancy way to hold the bougie and ETT together is any kind of an improvement.

The VL thing is interesting. Personally, I completely agree with you. On the other hand, some argue that eventually laryngoscopes won't even exist. The thinking is that VL is simply "better" than DL and as the tech improves, there will never be reason to use DL. Not unlike the way that CL's are now places exclusively under US, whereas just 10 years ago US was seen by many as just a novelty for that purpose.

I was trained to do PNB's 100% with US.......I could probably manage an axillary by landmark, but that'd be it, considering the landmarks for some of the blocks are different when you are relying solely on paresthesia or twitches.
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Random question for you and jwk. Do anesthesiology staff still know how to put in central lines by landmark? Can they do it without landmarks? Just pondering an idea I have about resus and putting in a PAC via IJ cordis, do all staff still know how to do that?
 
http://www.emdocs.net/novel-tips-airway-management/

Gents, the most recent research refutes your statements about VL. Fact is, a lot of those in EMS don't realize what happens after we transfer care, that began with our actions in he field.

The referenced article has good tips. I don't consider these gimmicks and frankly neither do the likes of ACEP, John Hinds, and ANNALS of EM

Your comment about taking too much time is also a point of contention I would refute. The recent literature actually points to passive pre-oxygenation as the answer to concerns of time. First pass success can be a reality. I don't think DL should go away either, but simply relegating advances in airway management seems like a good way to guarantee losing it. If we can't even argue for DL from the standpoint of current accepted research who would even give our arguments a chance?
 
MonkeyArrow said:
Random question for you and jwk. Do anesthesiology staff still know how to put in central lines by landmark? Can they do it without landmarks? Just pondering an idea I have about resus and putting in a PAC via IJ cordis, do all staff still know how to do that?
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Most anyone who has been practicing for more than say, 10 years or so probably didn't have US available during their initial training and their first few years of practice.

I learned landmarks and practiced them on manikins, but every actual CL I've done was with US. I don't think I've seen a CL done without US in years. I'm sure plenty of folks still do, but in many facilities it is policy to use US.
 
Remi said:
Most anyone who has been practicing for more than say, 10 years or so probably didn't have US available during their initial training and their first few years of practice.

I learned landmarks and practiced them on manikins, but every actual CL I've done was with US. I don't think I've seen a CL done without US in years. I'm sure plenty of folks still do, but in many facilities it is policy to use US.
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Hospital in MI I visited last week said the same. They had the luxury of having a few machines rolling around.

I can tell you that one of our busier trauma centers here in CHI has one rolling around the bay and residents are taught to use landmarks.
 
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