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Confirm correct placement of DLT (Bronchoscopy (Disadvantages (Resources:…
Confirm correct placement of DLT
Auscultation
Advantages
Cheap
Quick
Simple
No interference with ventilation
May work in the presence of blood or secretions
Disadvantages
Auscultation alone is unreliable (high false positive rate)
Difficult to assess once draped
May not work in the presence of lung pathology
Bronchoscopy
Method
Look through the tracheal lumen
Carina
Blue endobronchial cuff in the mainstem bronchus (no herniation)
Takeoff of UL bronchus
Position of the white radiopaque marker (4cm from the tip of the endobronchial lumen) slightly above the carina provides a margin of safety for positioning into mainstem bronchus
Look through the endobronchial lumen
Patency of UL bronchus
With a R sided tube this would include checking the alignment of the tube's lateral slit with the RUL bronchus
Recheck tube position after patient is repositioned
Advantages
Can insert DLT under direct vision using bronchoscopic guidance e.g. bronchopleural fistula
More reliable than auscultation - can also check the alignment of the right side DLTs lateral slit with RUL bronchus
Can be used to remove blood or secretions
Availability of FOB in theatre to help diagnosis and sometimes treat urgent intraop vent. problems e.g. pneumothorax, which can be difficult to distinguish clinically from tube malplacement
Promotes accurate knowledge of the anatomy of the tracheobronchial tree and familiarity with the use of endoscope
Disadvantages
Resources: need appropriately sized paeds bronchoscope (3.5mm bronch will pass through both lumens of 35F DLT, smaller DLT needs smaller bronch)
May not work in the presence of blood or secretions
Cost: initial outlay and servicing and repair
Training is required: learning curve is steep
Time consuming
Interference with ventilation and loss of PEEP during instrumentation
Airway trauma