Intubating and Exchange Catheters
Jan 09, 2025The art of swapping tubes without losing your cool!
You’ve seen them - those pesky long, floppy packages that flap around and are impossible to store neatly! 😅 But do you know what’s in them, and what they are used for? Here is your quick breakdown of intubating and exchange catheters! 📚
Starting with the most commonly used one - the bougie:
There have been a number of variations of bougies over the years, but essentially it is an intubating introducer designed to assist in intubation when the view of the glottis is inadequate 👀. It is shaped with a “hockey-stick” angle at the distal end, known as the coude tip, which is usually 35-40 degrees. The purpose of the tip is to assist in proper placement of the introducer beyond the vocal cords and into the trachea. 🎯
Some variations have external distance markings 📏, some have a central lumen and rapi-fit adapters for oxygenation 💨, some come with stylets to provide added rigidity 💪, and some have flexible, manoeuvrable tips 🔄.
Aintree Intubation Catheter:
Designed for use in exchanging a supraglottic device to an endotracheal tube 🔄. The aintree has a large internal diameter, meaning it can be railroaded over a slim/paediatric bronchoscope to allow for direct vision in the exchange process 👓. Because of this, the Aintree is much shorter in length at 50cm, compared with a standard bougie length of 70cm 📏.
The Aintree has external distance markings 📍, and comes with Rapi-Fit adapters to facilitate oxygen delivery 💨. ✅
Cook Retrograde Intubation set:
This facilitates tracheal intubation via the cricothyroid membrane. The Seldinger technique is used to introduce a guide wire in a retrograde fashion, exiting the airway via the mouth or nasal passage 👄👃, where an intubating catheter can then be fed over the guide wire and down into the trachea. ✅
Cook Airway Exchange Catheter:
Intended for exchanging endotracheal tubes 🔄, airway exchange catheters come in a variety of sizes to fit a range of different ETT sizes. The catheter is different from a bougie in that it has a blunt, straight tip designed to be atraumatic to internal structures, and is longer than a bougie at 83cm, allowing for advancement further down the trachea 🚶♂️. It has external distance markings 📏, a central lumen and distal sideports to allow for oxygenation via a rapi-fit adapter 💨. ✅
Arndt Airway Exchange Catheter:
Another option for supraglottic to ETT conversion 🔄, the Arndt kit comes with a guide wire 🧑⚕️ that can be fed down a bronchoscope for placement, with an exchange catheter that can be fed over the top to facilitate intubation. ✅
Cook Airway Exchange Catheter - Extra-Firm with soft tip:
Your one and only option for double lumen tubes 🔄! This catheter is much longer at 100cm 📏, and has a soft, flexible and blunt tip (the purple end!) which is designed to be atraumatic to the deeper structures of trachea and main bronchus. ✅
Each of these different catheters comes packaged with Rapi-Fit adapters 🧰. It's important to note that these adapters are not universal 🌐, and are sized differently to fit their corresponding catheter - they are not interchangeable 🔄!
And there you have it - your quick guide to all things airway catheters! 📚
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References:
Nickson, C. (2024) Bougie. LITFL https://litfl.com/bougie/
Nickson,C. (2024) Airway Exchange Catheters. LITFL https://litfl.com/airway-exchange-catheter/
Cook medical (2024). Products for the difficult airway. Cook medical https://cdnnamsseuspwsprod.azureedge.net/data/resources/CC-D62373-EN-F_M3_1687810056279.pdf
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