DLT Placement and Confirmation using GlideScope BFlex

I have been lucky enough to have the opportunity to work with Verathon, the makers of GlideScope (https://www.verathon.com/glidescope/) in order to help further my goal of medical education. As a (soon-to-be) cardiothoracic anesthesia fellow, the use of double lumen endotracheal tubes is common place in the OR. In this video, I demonstrate how I place a double lumen ETT with the use of a GlideScope, and then proceed to check for proper placement of said tube with a bronchoscope. (Please note, these techniques are my own and when performing any type of procedure or use of equipment, one should consult the users manual).

In general, double lumen endotracheal tubes are primarily used for lung isolation, meaning that they are used to preferentially ventilate only one lung during surgery or in the ICU. The dependent lung is the the lung NOT being operated on, and is usually the lung that is anatomically positioned down. I remember that the dependent lung is the lung being ventilated because it's the lung the patient is dependent on to live, while the other lung is being operated on. Once placed, we can then manipulate which lung, either both, one or the other, is being ventilated.

The initial placement of a DLT is the same as intubating using any other endotracheal tube, but quickly changes once our blue tip passes the cords.
1️⃣ For starters, it is crucial that the rigid stylet inside the tube is removed upon passing the cords with the tube as attempting to advance with it in place can result in potential tracheal damage or perforation.
2️⃣ Secondly, with a left sided DLT, the tube must be rotated to the left when being advanced. This helps to guide the endobronchial portion of the tube into the left mainstem bronchus.

Once inserted and advanced, I like to inflate my tracheal cuff and ensure that I can ventilate the patient normally. I have a tendency to not advance my tube far enough on my first insertion and as a result, will bronch the bronchial side first to see how far I am from the carina and left mainstem, and advance the two together until I am in place. I then proceed to bronch the tracheal lumen to ensure that my bronchial cuff is seated in the correct position within the left mainstem, and then can watch my bronchial cuff inflate to determine if it herniates or remains in place.

Thank you so much to @GlideScopevl for allowing me to help further my goal of medical education! What has your experience been with placing DLTs? Maybe you've never seen one! Share below!

*For educational purposes only. All views on posts are my own and do not reflect those of my institution or employer.
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Видео DLT Placement and Confirmation using GlideScope BFlex канала Count Backwards From 10