Aintree Intubation Catheter - Airway Device Difficult Airway Tutorials

Aintree Intubation Catheter

To reference this electronic educational resource according to the APA style for Web references, use:

Turk M, Gravenstein D (2007): Aintree Intubation Catheter Technique in Unanticipated Difficult Intubation. Retrieved <insert date of retrieval here>, from University of Florida Department of Anesthesiology, Center for Simulation, Advanced Learning and Technology, Virtual Anesthesia Machine Web site: http://vam.anest.ufl.edu/airwaydevice/aintree/index.html

Keywords: Aintree Intubation Catheter, Difficult Airway Management

See videos in the video library

Introduction

The Aintree Intubation Catheter (AIC, Cook Medical, USA) is a bougie tube designed for use with a fiberoptic bronchoscope (FOB) to facilitate endotracheal intubation through the standard Classic or Ambu laryngeal mask airway (LMA). The bronchoscope is placed through the lumen of the AIC (white tube) as shown below.

Aintree Intubation Catheter

The AIC is an adaptation of the Cook airway exchange catheter with a larger internal diameter (4.8 mm) to allow it to be pre-loaded onto a pediatric fiberoptic bronchoscope. Its external diameter allows its use with endotracheal tubes whose inner diameter is 7 mm or larger and it is 56 cm long and so will cover almost all pediatric bronchoscopes except the distal end. There are several reports of using it in unexpected difficult airways [1,2,3,4].

An unanticipated difficult airway presents challenges because of loss of upper airway soft tissue tone. This loss of upper airway tone will result in the walls of the upper airway opposing each other and obscuring the vocal cords and making mask ventilation difficult. In such situations, a laryngeal mask device is often employed. One method for bridging to an endotracheal tube is to place a bougie through the LMA. However, any blind passage of the bougie has the potential for trauma to the upper airway. The AIC loaded over a bronchoscope allows visually directed placement and avoids trauma and potentially delay. Use of the AIC has been described with the ProSeal LMA, intubating LMA and Tracheal Tube [5,6,7]. Also the AIC has been used in the ICU setting [8].

The AIC requires minimal skills with the bronchoscope [9]. In our technique, we prefer use of a laryngeal mask airway that has no aperture bars at the outlet which can interfere with visualization. The AIC comes with a Rapid Fit Connector (blue connector in picture above) which allows ventilation of the patient prior to removal of the LMA. The AIC and bronchoscope need to be well lubricated prior to the start of the procedure.

Insertion Technique in 7 easy steps:

1. Insert the laryngeal mask device in the recommended fashion.
2. With visual guidance, introduce the bronchoscope with the Aintree loaded onto it into the trachea.
3. Remove the bronchoscope leaving the Aintree in place.
4. Remove the laryngeal mask device leaving the Aintree in place
5a. Load the endotracheal tube (ETT) over the Aintree.
5b. Reintroduce the bronchoscope into the AIC to monitor AIC movement during ETT insertion (optional; not shown in video)
6. Advance the ETT into the trachea while holding the AIC securely in place
7. Remove the Aintree and confirm ETT placement with a CO2 monitor

Web author: Turk M, Gravenstein D

Reference Article List

Cook TM, Seller C, GuptaK, Thorton M, O’sullivanE: Non-conventional uses of the Aintree Intubation Catheter in management of the difficult airway. Anaesthesia. 2007, 62, pages 169-174
Blair EJ, Mihai R, Cook TM. Tracheal intubation via the Classic and Proseal laryngeal mask airways: a manikin study using the Aintree Intubating Catheter. Anaesthesia. 2007 Apr;62(4): 385-7
Mastakar S, Leschinskiry D. A response to ‘Airway rescue in acute upper airway obstruction using a ProSeal Laryngeal mask airway and an Aintree Catheter: a review of the ProSeal Laryngeal mask airway in the management of the difficult airway’. Anaesthesia. 2006 Jun; 61(6):618-9
Zura A, Doyle DJ, Orlandi M. Use of the Aintree Intubation Catheter in a patient with an unexpected difficult airway. Anaesthesia. 2005 Jun-Jul 52(6):646-9
Cook TM, Silsby J, Simpson TP. Airway rescue in acute upper airway obstruction using a ProSeal Laryngeal mask airway and an Aintree catheter: a review of the ProSeal Laryngeal mask airway in the management of the difficult airway. Anaesthesia. 2005 Nov;60(11):1129-36
Baskett PJF, Parr MJA and Nolan JP. The intubating laryngeal mask. Results of a multicentre trial with experience of 500 cases. Anaesthesia. 1998;53(12): 1174-1179
Genzwuerker HV, Vollmer T, EllingerK. Fibreoptic tracheal intubation after placement of the laryngeal tube. British Journal of Anaesthesia, 2002, 89(5)733-738
Rajendram R, McGuire N. Repositioning a displaced tracheotomy tube with an Aintree intubation catheter mounted on a fibreoptic bronchoscope. British Journal of Anaesthesia. 2006 97(4):576-579
Higgs A, Clark E, Premraj K. Low-skill fibreoptic intubation: use of the Aintree Catheter with the classic LMA. Anaesthesia. 60(9):915-920, Sept. 2005.




	VAM / Home	Last Updated 5/9/07
	Aintree Intubation Catheter To reference this electronic educational resource according to the APA style for Web references, use: Turk M, Gravenstein D (2007): Aintree Intubation Catheter Technique in Unanticipated Difficult Intubation. Retrieved <insert date of retrieval here>, from University of Florida Department of Anesthesiology, Center for Simulation, Advanced Learning and Technology, Virtual Anesthesia Machine Web site: http://vam.anest.ufl.edu/airwaydevice/aintree/index.html Keywords: Aintree Intubation Catheter, Difficult Airway Management See videos in the video library Introduction The Aintree Intubation Catheter (AIC, Cook Medical, USA) is a bougie tube designed for use with a fiberoptic bronchoscope (FOB) to facilitate endotracheal intubation through the standard Classic or Ambu laryngeal mask airway (LMA). The bronchoscope is placed through the lumen of the AIC (white tube) as shown below. The AIC is an adaptation of the Cook airway exchange catheter with a larger internal diameter (4.8 mm) to allow it to be pre-loaded onto a pediatric fiberoptic bronchoscope. Its external diameter allows its use with endotracheal tubes whose inner diameter is 7 mm or larger and it is 56 cm long and so will cover almost all pediatric bronchoscopes except the distal end. There are several reports of using it in unexpected difficult airways [1,2,3,4]. An unanticipated difficult airway presents challenges because of loss of upper airway soft tissue tone. This loss of upper airway tone will result in the walls of the upper airway opposing each other and obscuring the vocal cords and making mask ventilation difficult. In such situations, a laryngeal mask device is often employed. One method for bridging to an endotracheal tube is to place a bougie through the LMA. However, any blind passage of the bougie has the potential for trauma to the upper airway. The AIC loaded over a bronchoscope allows visually directed placement and avoids trauma and potentially delay. Use of the AIC has been described with the ProSeal LMA, intubating LMA and Tracheal Tube [5,6,7]. Also the AIC has been used in the ICU setting [8]. The AIC requires minimal skills with the bronchoscope [9]. In our technique, we prefer use of a laryngeal mask airway that has no aperture bars at the outlet which can interfere with visualization. The AIC comes with a Rapid Fit Connector (blue connector in picture above) which allows ventilation of the patient prior to removal of the LMA. The AIC and bronchoscope need to be well lubricated prior to the start of the procedure. Insertion Technique in 7 easy steps: 1. Insert the laryngeal mask device in the recommended fashion. 2. With visual guidance, introduce the bronchoscope with the Aintree loaded onto it into the trachea. 3. Remove the bronchoscope leaving the Aintree in place. 4. Remove the laryngeal mask device leaving the Aintree in place 5a. Load the endotracheal tube (ETT) over the Aintree. 5b. Reintroduce the bronchoscope into the AIC to monitor AIC movement during ETT insertion (optional; not shown in video) 6. Advance the ETT into the trachea while holding the AIC securely in place 7. Remove the Aintree and confirm ETT placement with a CO2 monitor Web author: Turk M, Gravenstein D Reference Article List Cook TM, Seller C, GuptaK, Thorton M, O’sullivanE: Non-conventional uses of the Aintree Intubation Catheter in management of the difficult airway. Anaesthesia. 2007, 62, pages 169-174 Blair EJ, Mihai R, Cook TM. Tracheal intubation via the Classic and Proseal laryngeal mask airways: a manikin study using the Aintree Intubating Catheter. Anaesthesia. 2007 Apr;62(4): 385-7 Mastakar S, Leschinskiry D. A response to ‘Airway rescue in acute upper airway obstruction using a ProSeal Laryngeal mask airway and an Aintree Catheter: a review of the ProSeal Laryngeal mask airway in the management of the difficult airway’. Anaesthesia. 2006 Jun; 61(6):618-9 Zura A, Doyle DJ, Orlandi M. Use of the Aintree Intubation Catheter in a patient with an unexpected difficult airway. Anaesthesia. 2005 Jun-Jul 52(6):646-9 Cook TM, Silsby J, Simpson TP. Airway rescue in acute upper airway obstruction using a ProSeal Laryngeal mask airway and an Aintree catheter: a review of the ProSeal Laryngeal mask airway in the management of the difficult airway. Anaesthesia. 2005 Nov;60(11):1129-36 Baskett PJF, Parr MJA and Nolan JP. The intubating laryngeal mask. Results of a multicentre trial with experience of 500 cases. Anaesthesia. 1998;53(12): 1174-1179 Genzwuerker HV, Vollmer T, EllingerK. Fibreoptic tracheal intubation after placement of the laryngeal tube. British Journal of Anaesthesia, 2002, 89(5)733-738 Rajendram R, McGuire N. Repositioning a displaced tracheotomy tube with an Aintree intubation catheter mounted on a fibreoptic bronchoscope. British Journal of Anaesthesia. 2006 97(4):576-579 Higgs A, Clark E, Premraj K. Low-skill fibreoptic intubation: use of the Aintree Catheter with the classic LMA. Anaesthesia. 60(9):915-920, Sept. 2005.