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This guideline is for paediatric anaesthetists and operating department staff and is to assist with planning for & institution of one lung ventilation for open thoracic or thoracoscopic procedures in anaesthetised children when deflation of a lung is necessary.
Children requiring one lung ventilation.
Paediatric anaesthetists and anaesthetic assistants.
|Age||ETT (ID)mm||ETT (ID)mm||Bronchial Blocker||Fibreoptic scope||Univent||Bronchocath (French gauge)|
|For selective endobronchial intubation consider microcuff in older child||for tracheal intubation & use with bronchial blocker||Arndt
RHSC stock - 5&7 French
|External diameter||Internal diameter
||Check stock in advance; infrequent use items|
|<6 months||2.5-3||3.5 (- smallest ETT for FO bronch)||5 French extraluminal||2.2mm||[Robertshaw no longer RHSC stock but GJNH have S/M/L R&L]
|6-12 months||3-3.5||4-4.5||5 French extraluminal||2.2mm|
|1-2y||3.5-4||4.5||5 French extraluminal||2.2mm|
|1-2y||3.5-4||5||5 French intraluminal||2.2mm|
|2-4y||4-4.5||5-5.5||5 French intraluminal||2.2mm|
|4-6y||4.5-5||5.5-6||5 French intraluminal||2.2mm||? 3.5mm|
|6-8y||5-5.5||6.0 +/- cuffed||5 or 7 French intraluminal||2.8mm||3.5mm|
|8-10y||5.5-6||6.5 +/- cuffed||5 or 7 French intraluminal||2.8mm||3.5-?4.5mm||28 (not normal stock)|
|10-12y||6-7.0||6.5-7 cuffed||5 or 7 French intraluminal||2.8mm||4.5-6mm||28-32 (not normal stock)|
|12-14y||6-7.0||7 cuffed||5 or 7 French intraluminal||2.8mm||4.5-6mm||35|
|14-16y||6-7.0||8-8.5 cuffed||7 - 9 French intraluminal||2.8mm||7mm||35|
|16-18y||6-7.0||8-8.5 cuffed||7 - 9 French intraluminal||2.8mm||7mm||35-37|
|Adult equipment||GJNH may have size 7&9, and possibly Vivasight 9 &
|GJNH may have size 8&9||GJNH stock sizes 35-41 (R&L)|
Assemble these items before connection to the patient. Screw adaptor should be opened enough to allow easy movement of blocker.
LUBRICATE WELL - it's easy to damage the small scope
Advance the scope into the bronchus, then advance the blocker over the bronchoscope.
You may need the vicryl loop a bit tighter than shown on the above picture.
Withdraw the bronchoscope but keep the balloon on the blocker in view, inflate the balloon under direct vision until it just occludes the bronchus & note the volume required.
When the blocker is confirmed as in the correct position, tighten the screw adapter to keep it secure & remove the vicryl loop by unscrewing the red & white cap from the proximal end of the blocker.
Lubricate tube v well, align blocker to blue line = posterior = large circumference side if ETT & pass through larynx under direct vision.
|Conical adapter in kit is to allow suction if required to help the lung deflate||One way of applying CPAP – clear plastic adapter is in blocker kit|
Opaque white connector with side port that fits green oxygen tubing = straight t-adapter (GE healthcare)
Alternative CPAP system allowing measurement of CPAP
|Connect green tubing to O2 (0.5 -1 lpm usually sufficient). Level 3 way tap with chest = 0 on scale of the ruler
ALWAYS have 3 way tap open to all ports, turn on O2 then fill open syringe barrel with saline to desired level of CPAP
Last reviewed: 24 May 2016
Next review: 24 May 2019
Author(s): Graham Bell, Deborah Fordyce
Approved By: Clinical Effectiveness