Upon opening the package, control that the device is not damaged, that the stylet is properly positioned inside the tube with its distal end inside the esophageal cuff. Both cuffs must be deflated before insertion. Proceed to lubrificating the tube with a hydrosoluble lubrificant.
With the patient’s head in a neutral position, perform the oropharyngeal introduction of the device: hold the tube like a pen with your dominant hand and with the help of the other hand insert the tube in the oral cavity, push it along the soft palate until you reach the right depth (the level indicator on the tube’s proximal end lies between the teeth). Such depth corresponds to the distal cuff sitting above the esophagus and the proximal one in the supraglottic position.

Inflate the cuffs with the syringe to an adequate pressure to isolate the supraglottic region and to allow ventilation through the Spritztube’s proximal lumen. Remove the stylet and connect the tube to the ventilation circuit or to a bag valve mask. The correct position is confirmed by auscultation or capnography.
If the ventilation fails, the reason  might be the tube’s incorrect positioning with its distal cuff sitting inside the trachea. In such case, remove the tube and repeat the insertion.
Once positioned correctly in this configuration, the device allows adequate ventilation and airway protection from regurgitation and aspiration, thereby achieving its objectives as a supraglottic airway device.

If the clinical situation requires it, the Spritztube offers a possibility to perform an orotracheal intubation, without having to replace the device, but simply changing its configuration by placing its proximal part into the trachea (like in a normal intubation procedure). It is possible to perform intubation with various methods:

  • - With a classic laryngoscope
  • - With a video laryngoscope
  • - With a Bonfils type rigid fiberscope
  • - With a flexible fiberscope

In the classic laryngoscopy, once the patient is sedated and curarized, disconnect the ventilation circuit, deflate the proximal cuff, introduce the blade in the throat, lift the epiglottis to access the glottis and insert the tube in the trachea. If the intubation proves difficult, you can revert to ventilation simply by re-inflating the proximal cuff and reconnecting the tube to the ventilation circuit, to take time to consider an alternative intubation method. Upon successful intubation, inflate the proximal cuff with sufficient pressure to occlude the tracheal lumen and continue ventilating the patient.

For intubation with a video laryngoscope (Glidescope, McGrath), disconnect the ventilation circuit, deflate the proximal cuff, introduce the blade in the throat  to view the glottis. Insert the stylet in the proximal end of the tube and introduce it into the trachea. Re-inflate the proximal cuff and ventilate the patient, with auscultation and capnography checks.

To use a Bonfils type rigid fiberscope disconnect the ventilation circuit and deflate the proximal cuff. Before introducing the endoscope, to ensure better visibility, it is recommended to aspirate any supraglottic secretions with a suction tube guided through the Spritztube. Now it is possible to insert the Bonfils through the Spritztube and push it to the distal opening, rotating it to get the right view angle of the glottis. Having reached the larynx under the instrument’s guidance, insert the Spritztube into the trachea, re-inflate the proximal cuff and ventilate the patient, with auscultation and capnography checks.

Another possible technique is using a flexible endoscope. After the supraglottic secretions aspiration, introduce the instrument through the specific bronchoscope/aspiration opening on the catheter mount, thus not interrupting the  ventilation. Proceed beyond the distal end of the tube until you view the vocal chords, pass through into the trachea and push the fiberscope to the carina. At this point, briefly disconnect the ventilation circuit, deflate the proximal cuff and push the tube into the trachea using the fiberscope as a guide. Once the tube’s distal end is correctly positioned in the trachea, inflate the cuff and ventilate the patient.