UNCONTROLLED WHEN PRINTED
Indications

Supraglottic device refers to i-Gel.

  • To manage and maintain a compromised airway in the patient with absent pharyngeal and laryngeal reflexes.
Contraindications
  • Intact gag reflex
Patient Factors & Considerations
  • Stabilise patient’s head and neck to avoid flexion, rotation or traction during placement
  • Confirm placement every time the patient is moved
  • Consider gentle use of laryngoscope blade as tongue depressor in infants
  • EtCO2 monitoring MUST be applied when available
  • Adopt a 30:2 regime during cardiac arrest with mechanical CPR device
Procedure

i-Gel®

  • Prepare equipment required:
    • Appropriate size i-Gel®
    • BVM
    • Disposable catheter mount
    • Lubricant (NB: Back, both sides and tip)
    • Oxygen
    • Stethoscope
    • Airway support strap
    • Suction
    • EtCO2
  • Select appropriate i-Gel® size according to patient weight as shown on packaging:
  • Apply lubricant to posterior surface of i-Gel® - this will aid in creating a good seal
  • Pre-oxygenate the patient if appropriate

  • Ensure airway is clear.
  • Place patient’s head in the ‘sniffing’ position using appropriate padding/ neutral position in suspected cervical spine trauma.
  • Push the mandible towards the thorax, insert the i-Gel® into the patient’s mouth (1) with the tip of the mask against the hard palate.
  • Glide the device as far as it will go along the hard palate until definitive resistance is felt.
  • Attach the catheter mount and EtCO2
  • Manually stabilise the device, gently inflate the lungs to test for air entry and seal.
  • Auscultate chest to confirm placement.
  • Secure the i-Gel® in a central position with the securing strap, or a tape-tie in smaller sizes.
  • The i-gel® forms a seal in the airway; this is referred to as a non-inflating cuff. 
  • It may take a few minutes to form a good seal - be mindful of ventilation pressure and timing of ventilation with chest compression if there is cuff leak). Adopting a 30:2 strategy may mitigate cuff leak in the first instance.

1
SGA - iGel insertion

2
SGA - iGel Teeth

3

SGA - iGel sitting

4
SGA - Intersurgical

Success
Success
Discontinue
  • Effective ventilations (i.e.: adequate chest rise and fall) cannot be achieved (some air leakage can be expected)
  • GCS of the patient increases with a return of gag reflex or patient attempts to remove
  • i-Gel is faulty.
  • Regurgitation occurs and is anticipated to be compromising

Removal of i-Gel

  • Remove securing tape/strap.
  • Suction if required.
  • If patient is conscious, instruct them to take a deep breath and cough as device removed
  • Remove the device gently by following the anatomical landmarks.
Additional Information
Additional information

References
References

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Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

Published Date

Review Date

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