To the Editor:
Both cuffs of a modern plastic double-lumen endobronchial tube (DLT) can be damaged by teeth or by the laryngoscope blade during intubation of the airway. The larger tracheal cuff is usually at greater risk than the bronchial cuff. When a cuff tear occurs, the tube must be replaced with an intact DLT. This is not only expensive, but requires additional time and may place the patient at increased risk while the airway is being secured.
We protect the tracheal cuff of Broncho-Cath[registered sign] DLTs (Mallinckrodt Medical, Inc., St. Louis, MO) in the following way (Figure 1 ). A 7 x 2-in. piece of pink or silk tape is folded in half, and the ragged edge is trimmed so that the final piece is 3 in. long by 2 in. wide. A 2-foot long piece of 1-in. wide clear tape is then folded lengthwise, leaving approximately 3 in. free at one end. This is torn in half lengthwise so that the final strip is approximately 1 foot long and 1/2 in. wide. The folded pink or silk tape is then wrapped around the tracheal cuff and secured with the sticky portion of the clear tape strip. A small amount of the sticky portion of the clear tape secures the strip to the main body of the DLT.
Figure 1: Our technique for protecting the tracheal cuff of a plastic double-lumen tube with strips of tape is shown.
During laryngoscopy, the tip of the bronchial lumen is advanced through the vocal cords. Once the protected tracheal cuff is past the teeth, the clear tape strip is pulled and the cuff protector slides up the body of the DLT. The tape cuff protector is removed and the DLT is rotated to the left and advanced down the trachea.
The tape cuff protector can be used for either or both cuffs of a DLT or for the cuff on a conventional endotracheal tube. We do not use this method routinely; however, it is especially useful during difficult intubations and for patients with prominent teeth. Over the past 6 mo, we have used this method successfully in 10 of these patients who required intubation with a DLT.
Gary P. Coppa, MD
Jay B. Brodsky, MD
Department of Anesthesiology; Stanford University School of Medicine; Stanford, CA 94305
