Pediatric Alternative Airways: A Picture Is Worth 1,000 Words

In last month’s article we looked at what types of information we need to consider when using pediatric alternative airways. They say a picture is worth 1,000 words, so let’s take an in-depth look at where that critical information can be found. Sometimes we just need to pay attention to the instructions!

King Airways/Laryngeal Tubes (Ambu)

Sizes for King LTS-D airways range from babies (<5 kg) to big people. Note: Contrary to appearances, the colors on the tops of King airways do not correspond to designations of the Broselow-Luten or Handtevy systems.

The packaging for the King LTS-D airway indicates:

1. The corresponding Broselow-Luten color codes based on head-to-heels measurement;

2. Recommendation for use based on patient weight range (in kg);

3. Recommended cuff inflation in milliliters of air.

The front of the King LTS-D airway allows you to confirm:

4. Recommendation for use based on patient weight range (in kg);

5. Recommended cuff inflation in milliliters of air.

The back of the King LTS-D airway indicates:

6. The size of the gastric access tube recommended.

AuraGain Laryngeal Mask Airways (Ambu)

Sizes for AuraGain laryngeal mask airways range from babies (<5 kg) to big people. 

The packaging for the AuraGain airway indicates:

1. Recommendation for use based on patient weight range (in kg);

2. The size of the gastric access tube recommended;

3. Recommended cuff inflation in milliliters of air.

The side of the AuraGain airway indicates:

4. The size of the gastric access tube recommended. 

The pilot balloon of the AuraGain airway indicates:

5. Recommendation for use based on patient weight range (in kg);

6. Recommended cuff inflation in milliliters of air.

air-Q sp Masked Laryngeal Airways (Mercury Medical)

Sizes for air-Q sp masked laryngeal airways range from babies (<4 kg) to big people. Note: Contrary to appearances, the colors on the tops of air-Q sp airways do not correspond to the Broselow-Luten or Handtevy systems. 

The packaging for the air-Q sp airway indicates:

1. Recommendation for use based on patient weight range (in kg). 

The back of the air-Q sp airway indicates:

2. Recommendation for use based on patient weight range (in kg).

Note: No cuff inflation is needed with this device. 

LMA Supreme (Teleflex)

Sizes for LMA Supremes range from babies (<5 kg) to big people. 

The packaging for the LMA Supreme airway indicates:

1. Recommendation for use based on patient weight range (in kg);

2. Recommended cuff inflation in milliliters of air.

The front of the LMA Supreme airway indicates:

3. Recommendation for use based on patient weight range (in kg); 

4. Recommended cuff inflation in milliliters of air. 

Note: The size of the gastric access tube recommended is found in the “instructions for use” available on the Teleflex website. 

i-gels (Intersurgical)

i-gel airways are similar to other laryngeal mask airways in many respects, but a significant difference is that they are made of a flexible silicone-like material that does not require inflation. In countries outside the United States, i-gels are used extensively in both prehospital and hospital-based care of children and adults.

Intersurgical, the manufacturer of i-gels, has indicated pediatric i-gels are not yet approved for prehospital/emergency resuscitation use in the United States. Intersurgical says it’s working toward obtaining U.S. pediatric i-gel approval; however, at this time any prehospital services using them with children should do so only under approval of their medical director.   

Conclusion

So what’s the takeaway message? When selecting and using pediatric alternative airways, the information is out there. You just have to know where to look and then read the directions before all else fails. 

Scott DeBoer, RN, MSN, CPEN, CEN, CCRN, CFRN, EMT-P, is an international pediatric seminar leader and nurse consultant with more than 30 years of nursing experience. He retired from flight nursing in 2015 following more than 20 years with the University of Chicago Hospitals’ UCAN flight team. He is the founder and primary seminar leader for Pedi-Ed-Trics Emergency Medical Solutions. 

Michael Rushing, NRP, RN, BSN, CEN, CPEN, CFRN, TCRN, CCRN-CMC, is AHA coordinator for Baptist Health Care, Pensacola, Fla., and paramedic adjunct professor at Northwest Florida State College, Niceville, Fla.

Lisa DeBoer, CET, NREMT, PI, is president and cofounder of Pedi-Ed-Trics Emergency Medical Solutions. 

Michael Seaver, RN, BA, is a healthcare informatics consultant based in Chicago.