|
The Levitan FPS (Clarus Medical) permits immediate placement verification in easy laryngoscopy, and fiberoptic intubation within 5 seconds for difficult airways. It is a shorter version of Clarus Medical’s original malleable stylet (Shikani Optical Stylet). If easy laryngoscopy, intubate in standard fashion, under direct view. Optical stylets offer fiberoptic technology with minimal change in practice, performed on first pass laryngoscopy.
The Levitan FPS (Clarus Medical) permits immediate placement verification in easy laryngoscopy, and fiberoptic intubation within 5 seconds for difficult airways. It is a shorter version of Clarus Medical’s original malleable stylet (Shikani Optical Stylet). If easy laryngoscopy, intubate in standard fashion, under direct view. Optical stylets offer fiberoptic technology with minimal change in practice, performed on first pass laryngoscopy.
 |
 |
The overall length is similar to a standard malleable stylet. Initial placement is by direct vision, like a standard stylet. |
Slight head adjustment switches the procedure from direct laryngoscopy to use of the eyepiece, permitting fiberoptic guided intubation. |
 |
 |
|
The Levitan FPS should be held with a pistol-type grip by the right hand (above). The tracheal tube tip should overlie the distal tip of the scope by approximately 1 cm. Initial placement position (achieved through direct visualization) is to have the tip down and away from epiglottis edge.
1) Fiberoptic instruments require a high skill level, but because of their ability to dovetail with laryngoscopy and be passed through supraglottic airways, this skill set adds a tremendous margin of safety in airway management.
2) The FPS is deliberately made to be short, allowing use with direct laryngoscopy. This requires the tube to be trimmed to approximately 28 cm (use trauma shears or other scissors), followed by reattachment of the 15-mm connector on the tube. Before use, check the tip
location, the 15-mm connector, and that the view through the FPS is clear. Since the tube overlies the distal FPS tip, the tube may need to be rotated on the hub to optimize the view. |
 |
 |
 |
(1) Laryngoscopy. If larynx easily exposed, intubate as usual,
fiberoptic viewing is not needed. |
(2) FPS placed into starting position under direct vision.
Scope stabilized in position.
|
(3) Head and eye move to the eyepiece for fiberoptic viewing.
|
 |
 |
|
(4) Navigate through cords (laryngoscope is then removed, freeing left hand). It is not necessary to go to carina. Do not withdraw device until tube is advanced within the trachea. |
(5) Advance the tube off FPS with left hand, using a clockwise rotation (white arrows), and then withdraw FPS scope (yellow arrows), directing eyepiece toward patient’s feet (easier removal due to distal bend of FPS). Verify tube depth (21 cm F, 23 cm M) at teeth.
|
|
Oxygen port on right side of hub: Setting flow at 2-5 lpm
keeps tip of scope clear of secretions and fogging. |
|
|
(1) Follow the open channel (stay off mucosa)
(2) Keep Perspective on the target
(3) Know your Starting position and proceed Slowly
|
 |
The tip of the scope is placed under direct vision beneath and slightly away from the epiglottis edge. Structures are harder to recognize when too close. Up close, the epiglottis will appear as a large curvilinear structure in upper half of view.
A fiberoptic instrument must move through an open channel, unlike a laryngoscope, which divides tissues. If against the mucosa (white or pink blur) > do not advance > back out > return to channel. With the FPS, the laryngoscope is used to create the navigable channel. This channel is enlarged by not over-extending the neck, but by distracting the jaw out and using ear-to-sternal notch patient positioning (see pages 6 and 36).
|
| |
|
 |
 |
 |
Malleable optical stylets can also be used without a laryngoscope for rapid oral fiberoptic intubation. Note dfferences in stylet shape with laryngoscope (straight-to-cuff 35 degrees vs. 65-75 degrees without laryngoscope (image right, above).
|
1) Rigidity and short length (compared to 60 cm flexible scope) make fiberoptic navigation and insertion easier. Bend angle should be 65ˆ75º, instead of 35º when used with a laryngoscope. Connect oxygen, 2-5 lpm.
2) Lift tongue and jaw with left hand while rotating tip of scope and tube between tongue and posterior pharynx. Use eyepiece as scope is inserted to stay within channel. Rotate tube clockwise off scope after passing through vocal cords, as leading edge of left-facing beveled tube can catch on rings |
|
|
|
 |
 |
 |
 |
1) Initial view shows epiglottis edge (superior) and posterior pharyngeal wall (bottom of image).
2) Advancement of scope under epiglottis with gentle rocking backward and lifting provides view of glottis and posterior landmarks.
3) Further advancement and centering of glottis.
4) Tracheal rings are visible superiorly, and flat posterior membraneous trachea is visible at bottom of image. Tube should be rotated clockwise off scope, and scope withdrawn toward patient's feet.
There are 3 important rules when using a fiberoptic instrument
(1) Follow the open channel (stay off mucosa)
(2) Keep perspective on the target
(3) Know your starting position and proceed slowly
A fiberoptic instrument must move through an open channel, unlike a laryngoscope, which divides tissues. If against the mucosa (white or pink blur) > do not advance > back out > return to channel.
|
The Bonfils scope (Karl Storz NA) is placed using a right-sided retromolar approach. After passing the epiglottis the tip is rotated up under it, and into the trachea.
 |
The Video RIFL (AI Medical) has an articulating tip that permits manipulation up and down to aid navigation.
 |
|
|
