Supraglottic Airway (SGA)

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

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

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

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

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

Colour assist:

Directorate

Clinical Services

Responsible Manager

Head of Clinical Services

Published Date

Review Date