EZ-Blocker®EZ-Blocker®

Jan. 2010

EZ-Blocker®EZ-Blocker®

A bronchoscope is mandatory

Bronchoscopic control for all in-, and deflations

EZ-Blocker®EZ-Blocker®

ETT Endotracheal tube

EZB EZ-Blocker®

DLT Double Lumen Tube

MPA Multiport Adaptor

PreparationsPreparations

PreparationsPreparations

Sterile cloth

ETT Lubricant Syringe Marker EZ-Blocker® set

EZB Multiport Adaptor Closing caps CPAP connection piece

PreparationsPreparations

Inspect for damage Remove protection shaft of the

EZB carefully by pulling the labelat the top of the shaft

Fix 2 blue closing caps on CPAP ports

Inflate cuffs to check for leakage Deflate completely vacuum Lubricate

PreparationsPreparations

(*)

PreparationsPreparations

Compare the lengths of EZB withETT plus MPA,place mark on the proximal shaftor remember distance in cm’s

The EZB should wedge on the carina within 8 cm from this mark (*). 4 cm towards the carina and 4 cm to wedge upon the carina

IntubationIntubation

IntubationIntubation ETT cuff directly behind the vocal cords

ETT tip to carina at least 4 cm

Connect MPA to ETT and start ventilating through MPA Approx. 100% O2

IntubationIntubation

Distal end ETT

4 cm

Carina

EZB extensions need 4 cm to spread before wedging the carina

EZB placementEZB placement

(*)

EZB placementEZB placement First action after intubation Check by

bronchoscope for abnormalities in anatomy Confirm: depth of ETT (4 cm to carina)

Insert EZB through MPA Check under vision closing main stem bronchus

and/or RUL -> if necessary manipulate cuff in right position

EZB placementEZB placement

Fiberscopic inspection of cuffs

Inflate the cuff in thetarget bronchus until Minimum Occlusive Volume (MOV) has been reached

Deflate the cuff vacuum

EZB Procedure lung collapseEZB Procedure lung collapse

Ventilate with deflated cuffs. Approx. 100% O2

Position the patient Disconnect ventilation from MPA as soon as the

surgeon enters the thoracic cavity Lung will collapse

EZB Procedure lung collapseEZB Procedure lung collapse If needed, the surgeon manipulates the lung to

the size of his desire After successful collapse, the cuff is inflated

under vision, start One Lung Ventilation Through resorption lung collapse will improve If collapsed lung starts ventilating again, deflate

cuff and disconnect ventilation -> re-collapse! When lung has the right size -> re-inflate cuff and

restart ventilation -> Always check with scope!

EZB removalEZB removal

End of operation deflate cuff. Vacuum!

Ventilate carefully to remove all atelectases

Block the other lung for bi-lateral procedure, or remove the EZB

The same ETT is used postoperatively

EssentialsEssentials

Essentials Essentials

ETT cuff must be introduced directly behind the vocal cords

EssentialsEssentials

First action after intubation Bronchoscopy

Confirm: Depth of ETT (4 cm from carina) and location of right upper lobe

If a cuff is not inflated, it should be deflated completely (vacuum)

Both cuffs should never be inflated at the same time †

EssentialsEssentials

After the EZB extends from the ETT, the EZB will wedge on the carina within ± 8 cm

After wedging the EZB on the carina, the ETT may be advanced a few cm for even more stability

No wedge? Both extensions situated in the same bronchus Check with scope, retry and/or withdraw ETT for

a few cm to provide space for spreading

EssentialsEssentials

ALWAYS withdraw your scope first

After that removethe EZ-Blocker

NEVER withdrawthe EZ-Blocker first

EssentialsEssentials

Deflate cuffs completely (vacuum) Carefully ventilate until all atelectases are gone PEEP is needed before wound closure Check lung expansion Remove Bronchoscope first, then the EZB Never jet-ventilate a patient with a EZB in place

-> The lung could be damaged