mark tozer's blog: EMS Airway Management - iGel Supraglottic Airway Device

The iGel supraglottic airway device is an essential tool for EMS providers when managing a patient's airway, especially in situations where endotracheal intubation may be difficult or not immediately feasible. 

Here’s some thing EMS providers need to know about the iGel:

1. Indications and Contraindications

Indications:

Emergency airway management in unconscious patients with absent or inadequate respiratory effort.
Alternative to endotracheal intubation during cardiac arrest, respiratory arrest, or when intubation is not possible.
Can be used in prehospital settings in combination with anesthesia, sedation, or other airway management situations requiring a secure airway.

Contraindications:

Conscious or semi-conscious patients with intact gag reflex.
Patients with known esophageal disease or pathology, such as esophageal varices.
Patients with a high risk of aspiration or who have ingested a large meal recently.
Severe airway trauma or obstruction that may prevent insertion.

2. Device Design and Features

Supraglottic Airway:

The iGel is designed to sit above the glottis, creating a seal around the laryngeal inlet without inflating a cuff.

Gel-Like Cuff:

The cuff is made of a soft, gel-like material that molds to the patient’s anatomy, minimizing trauma and reducing the need for precise sizing.

Integral Bite Block:

Built-in bite block helps prevent the patient from biting down and occluding the airway.

Gastric Channel:

The device includes a gastric channel that allows for the insertion of a gastric tube to decompress the stomach and reduce the risk of aspiration.

Sizing:

The iGel comes in multiple sizes, typically based on patient weight, ranging from neonates to large adults.

3. Preparation and Insertion

Sizing:

Select the appropriate size based on the patient’s weight.
Typical size ranges are:Size 1: Neonates (2-5 kg)
Size 2: Pediatric (10-25 kg)
Size 3: Small adult (30-60 kg)
Size 4: Medium adult (50-90 kg)
Size 5: Large adult (90+ kg)

Lubrication:

Lubricate the back, sides, and cuff of the device with a water-based lubricant.
Avoid over-lubricating the front of the device to prevent blocking the airway opening.

Insertion Technique:

Position the patient’s head in a neutral or slightly extended position.
Open the patient’s mouth and gently insert the iGel along the natural curve of the airway until resistance is felt, indicating it is seated correctly.
Avoid excessive force during insertion to prevent trauma.

Confirmation:

Confirm placement by observing chest rise, listening for bilateral breath sounds, and using capnography (if available).
Secure the device with a strap or tape to prevent dislodgement.

4. Maintenance and Monitoring

Ongoing Assessment:

Continuously monitor for effective ventilation, chest rise, and oxygen saturation.
Regularly check for signs of dislodgement, obstruction, or leakage.

Gastric Decompression:

If necessary, insert a gastric tube through the gastric channel to decompress the stomach and reduce the risk of regurgitation and aspiration.

Ventilation:

Connect the device to a bag-valve mask (BVM) or ventilator, ensuring adequate tidal volume and oxygen delivery.

5. Complications and Troubleshooting

Airway Obstruction:

If ventilation is inadequate, reassess the device placement, and consider repositioning or reinsertion.

Aspiration Risk:

Despite the gastric channel, there is still a potential risk of aspiration; be prepared to manage this complication if it occurs.

Device Dislodgement:

Regularly check the device's position and secure it properly to avoid dislodgement, especially during patient movement or transport.

Trauma or Discomfort:

Monitor for signs of airway trauma or discomfort, particularly if insertion was difficult.

6. Removal

Timing:

The iGel should be removed once the patient regains consciousness and airway reflexes, or if endotracheal intubation is indicated.

Technique:

Gently withdraw the device while monitoring for any signs of obstruction, aspiration, or respiratory distress.
Prepare to manage the airway immediately if complications arise during removal.

7. Training and Proficiency

Simulation Training:

Regular practice with the iGel device in simulated scenarios to maintain proficiency in its use.

Familiarization:

EMS providers should be familiar with the different sizes and specific features of the iGel, including the gastric channel and the appropriate insertion technique.

Continuing Education:

Stay updated on best practices, new developments, and guidelines related to supraglottic airway management.

8. Legal and Ethical Considerations

Scope of Practice:

Ensure the use of the iGel is within the provider’s scope of practice as defined by their certification level and local protocols.

Informed Consent:

While typically used in emergencies where consent cannot be obtained, providers should be aware of the ethical considerations in airway management.

Documentation:

Document the size of the device used, time of insertion, confirmation methods, patient response, and any complications encountered.

Conclusion

The iGel supraglottic airway device is a valuable tool in the EMS provider’s airway management arsenal. Proper selection, insertion, and management are crucial to ensure effective ventilation and patient safety. It was invented by Dr. Muhammed Aslam Nasir and is manufactured by Intersurgical.

Continuous training and familiarity with the device will enhance the provider's ability to use the iGel effectively in emergency situations.

mark tozer's blog

Thursday, August 01, 2024

EMS Airway Management - iGel Supraglottic Airway Device