Intact gag reflex.
Patients less than 5 feet in height.
Known esophageal disease.
Caustic substance (acid or lye) ingestion.
c. Side Effects and Complications.
(1) An increased incidence of sore throat, dysphagia, and upper airway
hematoma as compared to ETT.
Esophageal rupture is a rare complication, but has been described.
(3) Complications may be partially preventable by avoiding over-inflation of
the distal and proximal cuffs.
(4) Take appropriate BSI precautions, including facial protection, as
vomiting can occur through the Number 2 tube if the initial placement is in the
d. Intubation Procedures.
Inspect the upper airway for visible obstruction.
Hyperventilate (> 20/min) the patient for 30 seconds.
Position patient's head in a neutral position.
(4) Test both cuffs (white and blue) for leaks by inflating with 15 ml (white)
or 100 ml (blue) of air.
Insert the Combitube in the same direction as the natural curvature of
(a) Grasp the tongue and lower jaw between your thumb and index
fingers and lift upward (jaw-lift maneuver).
(b) Insert the Combitube gently, but firmly, into the pharynx until the
black rings on the tube are positioned between the patient's teeth.