Author: admin

1. Introduction; concept and anatomy.

2. Sterility

The Tulip is a single-use device, and as such, is supplied in a sterile package, which must be discarded if the sterile seal is broken in any way. Once used, the Tulip should be disposed of as contaminated waste.

4. Inflation and Deflation

This is preferably done using a dedicated air-filled 60ml syringe, as the whole cuff may be inflated in one go to its recommended 60mls volume, saving time. Initially, this should be done to over-inflation, as per the pre-use checks.

The Tulip is designed to be “one-size-fits-all-adults” and is designed to be “insert-to-fit” and “inflate-to-fit”.

5. Cuff, Sizing and the Principles of Fitment

The principle of the Tulip is based upon a totally air and secretion-tight seal being achieved in the oropharynx by an expanding high-volume, low-pressure inflatable balloon-cuff which then allows ventilating pressure to be generated. The balloon-cuff is anatomically designed and provides an anatomical fit.

8. Securing and Maintaining the Airway

Be careful not to allow the weight of the breathing circuit to twist or displace the light-weight Tulip when connected (see 7.14).

Connect to the gas supply, holding, securing then mounting the breathing tube to prevent displacement and gently inflate the lungs and confirm correct placement using a stethoscope and/or monitoring e.g. capnography.

9. Spontaneous Ventilation

The Tulip has a large diameter breathing tube with low resistance to spontaneous breathing so it allows good oxygenation and CO2 elimination with good tidal volumes during spontaneous ventilation. The Tulip also has a large low pressure balloon-cuff that establishes a strong, competent seal for intermittent manual ventilation of the Patient to higher levels than is usually required (>20cmH2O).

12. Malposition of the Tulip

Insertion of a Tulip is simple, and it is designed to be effective even in the hands of non-medical personnel.

13. Light anaesthesia

If anaesthesia is inadequate, the Patient’s chest compliance may fall, as there is an increase in muscular tone. The emergence of the Patient may stimulate breath holding, coughing or straining. Furthermore, light anaesthesia may induce laryngospasm or bronchospasm, both of which may cause the ventilation pressures to rise above the normal levels recommended (+/-20cmH2O).

14. Management in positive pressure ventilation.

The Tulip has been designed to be easily introducible, with an effective ventilatory seal that operates at 60mls volume under normal circumstances. This enables manual ventilation at +/-20cmH2O normally. This enables the Tulip to be used with intermittent positive pressure ventilators when required.

15. Emergence from Anaesthesia.

• The Tulip is best removed in a fully staffed and equipped recovery area, which allows full monitoring and suction.
• The Anaesthetist must check the Patient’s ventilation, and confirm a clear ventilating airway before handing over the Patient to recovery staff.
• The Tulip is to be left in place fully-inflated when leaving theatre and it is recommended that visualized oral suction, external to the Tulip, be performed prior to leaving the operating theatre.