Individual Blockers
Uni Blocker
EZ Blocker
Tips to Troubleshoot
Correct placement can be problematic if the limbs of the Y do not separate adequately, thus allowing both limbs to enter the lumen of either the left or, more usually, the right main bronchus. This can occur in patients with a short trachea,4 or if the tube is placed too deeply towards the carina.1 The usual corrective maneuver is to retract the tube and blocker under fibrescopic vision until the limbs of the blocker open and then advance the blocker on to the carina.
Recently, Rispoli et al.1 published a practical guide for using the EZ-Blocker. Troubleshooting options mentioned in their publication included cuff-inflated positioning techniques and left main bronchus positioning of the tube and blocker followed by retraction. Both are very useful alternative techniques to attain correct EZ-Blocker positioning.
A third option to correct the position of the EZ-Blocker is external tracheal manipulation. The Electronic Supplementary Material eVideo shows that in our case both limbs of the EZ-Blocker have entered our patient’s right main stem bronchus on initial placement. The tube is also too deep as there should be 4 cm of free tracheal space between the end of the tube and the carina.1
Instead of retracting the tube, only the EZ-Blocker is retracted to just above the carina. Subsequently, gentle external manual displacement of the trachea to the right brings the carina closer to the EZ-blocker, allowing advancement to the correct position over the carina. This procedure requires two operators: operator 1 for the fibreoptic bronchoscopy, and operator 2 for the tracheal displacement and the manipulation of the EZ-blocker. We use a videobronchoscope with the screen visible to all operators.
Right displacement of the trachea has previously been described to aid the correct placement of a left double-lumen tube.5 This maneuver using right external tracheal manipulation has not previously been described for the repositioning of an incorrectly placed EZ-Blocker. [10.1007/s12630-024-02767-5]
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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