Insertion of an i-Gel

Question 1

What are the indications for insertion of an I-Gel?

Answer 1

1. Unconscious pt without a gag reflex
2. Ineffective ventilation with a BVM and basic airway Mx
3. > 10mins assisted ventilation required
4. Unable to intubate

Question 2

What are the contraindications for insertion of an I-Gel?

Answer 2

1. Intact gag reflex
2. Resistance to insertion
3. Strong jaw tone or trismus
4. Suspected epiglottitis
5. Suspected U.A.O
6. The use of sedation is C/I to assist or maintain placement

Question 3

What are the precautions for insertion of an I-Gel?

Answer 3

1. Inability to prepare pt in sniffing position
2. Pts who require higher airway pressures
3. Significant vomit in airway
4. Pts ≤14 due to enlarged tonsils (MICA only)

Question 4

What other precaution/side effect is noted about I-Gels?

Answer 4

Correct placement does not prevent passive regurgitation or gastric distension.

Question 5

How should the head be positioned for I-Gel insertion?

Answer 5

External auditory meatus should be in line with the suprasternal notch (sniffing position).
- Consider neck injury

Question 6

What breadth should the mouth be opened to for I-Gel insertion?

Answer 6

Pull down lower jaw to three fingers breadth.

Question 7

If unable to open mouth to specified breadth for I-Gel insertion, what should be done instead?

Answer 7

Consider OPA or NPA and return to BVM.

Question 8

What colour/size SGA and OG tube should be used for a pt that weighs 30-60kg?

Answer 8

Size 3 SGA (yellow) with a size 12 FG.

Question 9

What colour/size SGA and OG tube should be used for a pt that weighs 50-90kg?

Answer 9

Size 4 SGA (green) with a size 12 FG.

Question 10

What colour/size SGA and OG tube should be used for a pt that weighs >90kg?

Answer 10

Size 5 SGA (orange) with a size 14 FG.

Question 11

What hand should the I-Gel be inserted with?

Answer 11

Left.

Question 12

What direction should the I-Gel be facing for insertion?

Answer 12

Cuff outlet facing pts chin.

Question 13

If resistance is encountered early in I-Gel insertion, what is the troubleshooting?

Answer 13

Rotate clockwise and anticlockwise 20 degrees while inserting into the oropharynx.

Question 14

In pts with enlarged tonsils, the I-Gel may…?

Answer 14

Rotate 180 unintentionally during insertion.

Question 15

If cricoid pressure is being applied, when should it be removed during I-Gel insertion?

Answer 15

When confirming the position.

Question 16

How is correct placement of the I-Gel assessed for the pt in cardiac arrest?

Answer 16

Look for rise and fall of chest for as short a period as possible.

Question 17

How is the correct placement of the I-Gel assessed for the non-arrested pt?

Answer 17

Auscultate chest and abdomen, listening for air entry.

Question 18

What is the troubleshooting if an inadequate seal for the I-Gel is detected?

Answer 18

Rotate stork 75 degrees clockwise with downward pressure, and then rotate 75 degrees back anticlockwise (ice-cream scoop).
If this fails, use jaw thrust to open space posterior to the tongue in the pharynx and reinsert.

Question 19

How are gastric tubes measured?

Answer 19

From the xiphisternum around the ear, to the tip of the LMA - tape the identified length.