A significant benefit of the i-gel device is its gastric access port, which is an integral safety feature. It allows for gastric decompression and clearance of pharyngeal secretions without removing the airway device, minimizing the risk of aspiration in compromised patients. Successful suctioning depends on meticulous preparation and a firm grasp of the technique.
Preparing for the Procedure
Before initiating the suctioning procedure, proper preparation is essential to ensure patient safety and procedural efficiency. This involves gathering the necessary equipment and preparing both the patient and the i-gel device.
Essential Equipment Checklist
- Suction device (manual or wall-mounted) with appropriate tubing
- Suction catheter (size-appropriate for the i-gel's gastric channel)
- Water-based lubricant (e.g., Muko gel)
- Standard saline or sterile water for clearing catheter
- Personal Protective Equipment (PPE)
- Monitoring equipment (capnography, pulse oximetry)
- Confirmation devices (e.g., stethoscope, ETCO2 detector)
Patient and i-gel Preparation
- Confirm Placement: Verify the i-gel is correctly positioned and secured. Proper placement is confirmed by listening for bilateral breath sounds and observing an ETCO2 waveform. If confirmation is not clear, troubleshoot before suctioning.
- Measure Catheter Depth: Use the i-gel's packaging or measure the catheter against the i-gel itself to determine the appropriate depth. Mark the catheter with tape to prevent over-insertion, which could cause trauma. Over-insertion is a significant risk, especially in the gastric channel where it could potentially enter the trachea if the device is improperly seated.
- Lubricate: Apply water-based lubricant to the end of the suction catheter. This ensures smooth passage through the i-gel's gastric channel, preventing damage to the device or patient.
- Prepare Suction: Set the suction device to the recommended pressure, typically between 80 and 120 mmHg. Ensure the suction tubing is connected and operational.
Step-by-Step Suctioning Technique
Once prepared, follow these steps precisely to ensure safe and effective clearance of secretions.
- Insert the Catheter: Gently feed the lubricated suction catheter into the gastric channel of the i-gel. The catheter should pass smoothly until the depth marker reaches the outer edge of the channel. Stop immediately if resistance is met.
- Apply Suction: Cover the control port of the suction catheter to apply intermittent suction. Do not apply continuous suction for more than 15-20 seconds to avoid hypoxia or tissue damage.
- Withdraw and Observe: While applying suction, slowly withdraw the catheter. Observe the contents being suctioned. After clearing, turn off the suction but leave the catheter attached if further suctioning is anticipated.
- Repeat as Needed: If more secretions are present, repeat the process. Always monitor the patient's vitals, particularly oxygen saturation and heart rate, throughout the procedure.
Comparison: Suctioning via i-gel vs. Endotracheal Tube (ETT)
| Feature | i-gel Supraglottic Airway | Endotracheal Tube (ETT) |
|---|---|---|
| Insertion | Faster and easier insertion; often successful on first attempt. | Can be more difficult and time-consuming; requires laryngoscopy. |
| Aspiration Risk | Reduced risk due to gastric channel allowing suction of stomach contents. | Requires separate access for gastric decompression, potentially higher risk during placement/removal. |
| Cuff Type | Non-inflatable, soft gel-like cuff reduces trauma. | Inflatable cuff that requires careful pressure management to avoid tracheal damage. |
| Pharyngolaryngeal Morbidity | Significantly lower incidence of sore throat, dysphagia, and trauma. | Higher rates of post-procedural complications, including sore throat and hoarseness. |
| Hemodynamic Response | Minimal change in heart rate and blood pressure during insertion compared to ETT. | More pronounced hemodynamic response (increased heart rate and MAP) during insertion. |
Troubleshooting Common Issues
Leakage Around the i-gel
If you observe excessive leakage during ventilation, it may indicate improper device size or placement. First, ensure the device is not dislodged. If the i-gel has not been fully inserted, it might cause a leak. Reinsert with gentle jaw thrust. If the leak persists, consider trying a different size, though this may require removing and potentially replacing the device entirely.
Ineffective Suction
If the catheter appears to be in place but no fluid is suctioned, check the following:
- Is the catheter blocked? Withdraw and clear the catheter with saline.
- Is the suction unit working properly? Check tubing connections and power.
- Is the catheter obstructed by the i-gel? Gently rotate the catheter as you advance it. If fluid or secretions are visible in the oral pharynx but not being removed, the i-gel seal may be compromised and require removal and decontamination of the airway.
Safety Precautions and Considerations
- Always use intermittent suction. Prolonged continuous suction can lead to hypoxemia. Adhere to the 15-20 second limit per suctioning pass.
- Never force the catheter. Resistance can indicate improper alignment, excessive depth, or anatomical obstruction. Forcing the catheter can cause significant trauma.
- Monitor Patient Vitals. Continuously monitor the patient's oxygenation and end-tidal CO2. Interruptions in capnography may indicate an issue with the circuit or device.
- Observe Contraindications. Not all patients are suitable candidates for an i-gel, especially those with an intact gag reflex, known caustic ingestion, or severe airway trauma.
- Secure the Device. Ensure the i-gel is properly secured with the provided strap to prevent accidental dislodgement during procedures. More information on supraglottic airway complications can be found from authoritative sources like the National Institutes of Health.
Post-Procedure Care
Following successful suctioning, re-evaluate the patient's airway status. Confirm adequate ventilation and re-check vital signs. If the i-gel is to be removed, ensure suction is ready for use, and gently remove the device with firm, steady traction. The oral cavity should be suctioned again as needed to clear any remaining secretions.
Conclusion
Suctioning through an i-gel is a critical skill for emergency and intensive care professionals, providing a safer method for clearing secretions and gastric contents in patients with compromised airways. By following the correct procedure, preparing all equipment in advance, and adhering to strict safety protocols, clinicians can effectively manage the patient's airway while minimizing risks such as aspiration and trauma. Regular practice and a thorough understanding of the device's capabilities are key to successful patient outcomes.
