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Pediatric I-Gel Placement
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Pediatric I-Gel Placement
MMT Clinical Education
What is an I-Gel?
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I-gel is a second generation supraglottic airway, made of a medical grade thermoplastic elastomer, designed to create a non-inflatable anatomical seal of the pharyngeal, laryngeal and perilaryngeal structures. I-gel comes in four pediatric and three adult sizes.
Why use I-Gel?
Key factors/function
Key components and their function
- Soft non-inflatable cuff
- Gastric channel for regurgitation, which significantly reduces potential for regurgitation to get past the cuff and therefore aids in reducing the chance for aspiration. Please note size one i-gel does not have a gastric channel.
- Provides “vent” for gastric pressure and stomach decompression.
- Epiglottic rest keeps the device from moving upwards out of position and prevents the epiglottis from down folding or obstructing the distal opening
- Buccal cavity stabilizer a built in natural curvature and propensity to adapt its shape from the patient’s anatomy, the widened design also provides vertical strength and prevents rotation.
Why use I-Gel?
Why Use I-Gel?
Ease and speed of insertion
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Reduced trauma
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Superior seal pressure
Ease and speed of insertion
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Ease and speed of insertion
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Ease and speed of insertion
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Parts of the I-gel
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PARTS OF THE I-GEL
Contraindications
Indications
- Responsive patient with intact airway –protective reflexes
- Patients with known esophageal disease
- Caustic ingestions
- Upper-airway obstructions due to foreign bodies or pathology
- Trismus, limited mouth opening, airway abscess, trauma or mass
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- Airway management in pediatric cardiac arrest
- Inability to intubate when rapid control of airway is essential
- Difficult airway cases
- Passive oxygenation during cardiac arrest
INDICATIONS/CONTRAINDICATIONS
Who can insert?
Who can insert an I-Gel?
ALS providers who have reviewed the I-Gel powerpoint and then have passed 10 question quiz with a 100%!
Warnings
+I-gel must be lubricated according to the instructions for use
+Patient should be in “sniffing” position, unless head/neck movement are contraindicated
+Leading edge of i-gel tip must follow the curvature of the patient’s hard palate upon insertion
+Excessive air leak during manual ventilations is a result of sub-optimal depth of the i-gel
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WARNINGS &
EQUIPMENT
Complications
Complications and Risks of insertion
- Laryngospasm, sore throat
- Cyanosis
- Tongue numbness
- Trauma to the pharyngo-laryngeal framework
- Down-folding of epiglottis (more common in children)
- Gastric distention, regurgitation, aspiration
- Nerve injuries, vocal cord paralysis, lingual or hypoglossal nerve injuries
- If placed too high in pharynx, may result in a poor seal and cause excessive leakage
- If I-gel tip enters glottic opening, will have excessive air leak through gastric channel and obstruction to airflow
Equipment
Equipment
- BVM
- Lubricant
- EtCO2 sensor
- Gastric tube
- Suction
- I-Gel
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Pediatric Tube Sizing
TUBE SIZING
Color coded
I-Gels are color coded
Select the appropriate size i-gel by assessing the patient’s anatomy. Although size selection on weight basis should be applicable to the majority of patients, individual anatomical variations mean the weight guidance provided should always be considered in conjunction with clinical assessment of the patient:
Color size. weight
White =i-gel®, supraglottic airway. 2.5 25–35kg large pediatric
Black= i-gel®, supraglottic airway. 2 10–25kg small pediatric
Blue = i-gel®, supraglottic airway 1.5 5–12kg infant
Pink = i-gel®, supraglottic airway 1 2–5kg neonate
Important notes!
Inspect Devices
- Airway patency: Confirm no foreign body or lubricant obstructing distal opening or gastric channel
- Inspect inside bowl, ensuring surfaces are smooth and intact & patent gastric channel
- Discard if device abnormal or deformed
- Ensure 15mm connector is secure
- Do not place device directly onto patient's chest or surface near patient’s head; always place in protective cradle/cage pack after lubrication, pending insertion
- Do not use unsterile gauze or your finger to help lubricate device
- Do not apply lubricant too long before insertion (need to maintain moisture)
Suction
Suction
-An NG or suction catheter may be inserted into gastric channel
-Maximum size of the suction catheter that can be inserted down the I-gel is limited for pediatric I-Gels:
-Size 2=suction catheter size 12 (french/US gauge)
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PROCEDURE
Procedure:
1. Place patient on a flat surface and place in the appropriate sniffing position
Monitor ECG, vital signs.
2. Pre-oxygenate patient with a BVM on high flow oxygen at 15 LPM until ready to insert the supraglottic airway.
3. Suction as necessary prior to insertion of supraglottic airway.
4. Select the appropriate size i-Gel.
5.Remove the i-Gel and transfer it to the palm of the same hand that is holding the protective cradle.
6. Place a small amount of lubricant onto the middle of the smooth surface of the cradle and lubricate the back, sides, and front of the cuff.
7. Grasp the lubricated i-Gel along the integral bite block so the i-Gel cuff outlet is facing towards the chin of the patient.
8. Press down on the chin to open the patient's mouth and introduce the soft tip in the direction of the hard palate.
9. Place the device downward and backwards along the hard palate with a continuous but gentle push until you feel definitive resistance.
10. The tip of the airway should be located into the upper esophageal opening and the cuff should be located against the laryngeal framework. The incisors should be resting on the integral bite block.
Each attempt shall not exceed 30 seconds. An attempt is defined as insertion of the tube between the teeth and/or gums
11. The i-Gel should be secured with the straps provided in the kit, or tape may be an appropriate substitute.
12. Confirm proper placement with end-tidal capnography, chest rise, and auscultation of lung sounds.
13. Make every attempt to minimize movement of patient's head due to the high possibility of displacement.
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POST PLACEMENT
Post Placement/ Reassesment
- Frequently reasses to detect displacement and complications (especially after movement or status/condition changes)
- ETCO2
- Lung sounds
- SpO2
- HR
- BP