30. Trouble-Shooting
30. Trouble-Shooting
The Tulip is designed to be easily introducible without the need to perform any form of visualization. The single adult size is designed to fit a majority of adults who lie within the considered normal range by virtue of an anatomical inflatable cuff which expands to form an oropharyngeal seal between the soft palate, the epiglottis and oropharyngeal walls. This expanding cuff expands to fill the oropharynx up to a point of contact with the mucosa where the seal is formed. This consequently means that the cuff inflates to fit each individual oropharynx allowing a custom anatomical fit for each individual Patient.
| Problem | Likely Cause | Corrective Steps |
|---|---|---|
| Coughing/Straining
Laryngeal spasm |
>Light anaesthesia
>Light anaesthesia |
>Deepen anaesthesia
>Deepen anaesthesia |
| Inability to introduce | >Tulip tip inserting into vallecula anteriorly | >Remove and re-insert along hard palate posteriorly |
| >Insert Tulip semi-inflated (+/-30mls) | ||
| >Tonsils or tongue causing obstruction | >Re-insert and visualize insertion into oropharynx | |
| >Insert Tulip semi-inflated (+/-30mls) | ||
| >Tulip tip impacting on back of mouth/throat/oropharynx | >Guide the Tulip tip into oropharynx by flexing the tube | |
| >Insert Tulip semi-inflated (+/-30mls) | ||
| Inability to ventilate after cuff inflation | >Light anaesthesia | >Deepen anaesthesia |
| >Laryngeal spasm | >Deepen anaesthesia | |
| >Short acting paralysis | >Give more paralyzing agent | |
| >Mechanical obstruction | >Relieve kinking, twisting or blockage | |
| >Check Tulip insertion depth | ||
| >Check over-insertion | ||
| >Check under-insertion | ||
| Inflate cuff to 60mls or more | ||
| >Secretions | >Careful suctioning | |
| >Anatomical obstruction | >Remove and re-introduce | |
| >Inflate cuff to 60mls or more | ||
| >Bronchospasm | >Exclude asthma, COAD and anaphylaxis | |
| >Exclude aspiration | ||
| >Exclude pneumothorax | ||
| Patient obstructed | >Tube twisted, kinked or blocked | >Relieve obstruction |
| >Tulip misplaced in vallecula | >Remove, deflate and re-insert | |
| >Secretions | >Careful suctioning | |
| Ventilatory leak | >Inadequate inflation | >Top-up inflation to 60mls or more |
| >Inflate to fit | ||
| >Cuff rupture | >Replace Tulip | |
| >Decreased compliance | >Bronchospasm | |
| >Laryngospasm | >Deepen anaesthesia | |
| >Light anaesthesia | >Deepen anaesthesia | |
| >Inadequate paralysis | >Give more paralyzing agent | |
| >Anaphylaxis | >Treat | |
| >Excessive ventilation pressure | >Down regulate pressure | |
| Laryngeal spasm | >Inadequate anaesthesia | >Deepen anaesthesia |
| >Surgical stimulation | >Cease surgical stimulation | |
| >Aspiration | >Suction and intubation | |
| Displacement after introdcution | >Inadequately secured | >Secure properly; Tie or stick |
Dr. Amer Shaikh, October 2011.
