While the information contained within this video was considered correct by Intersurgical at the time of production, it in no way qualifies anyone to undertake any medical activity. Intersurgical can accept no responsibility for the medical practices of persons who directly or indirectly reference this programme.
The i-gel® is a novel and innovative supraglottic airway management device
made of a medical grade thermoplastic elastomer which is soft gel like and
transparent. It took over five years of development to perfect a non inflatable
anatomical seal of the pharyngeal laryngeal and peri laryngeal structures
that would reduce compression trauma. A supraglottic airway without an
inflatable cuff has several potential advantages including easier insertion
minimal risk of tissue compression and stability after insertion. i-gel® is a
latex-free single patient use device that has a gastric channel to reduce the risk of aspiration.
Key components and their function
The soft non inflatable gel-like cuff matches the shape and softness of the laryngeal and perilaryngeal frameworks
It helps to provide easy and rapid insertion and reduces the potential for post-operative trauma.
An integral gastric channel is provided to reduce the risk of aspiration and allow for passing of a nasogastric tube.
The buccal cavity stabilizer eliminates the potential for rotation and aids insertion.
An epiglottic rest helps to prevent the
epiglottis from down folding or obstructing the distal opening of the airway.
The 15 millimeter connector extends inside the airway tube far
enough to provide an integral bite block.
Pre-insertion preparation
i-gel® is supplied in a sterile pouch enclosed in
either a protective cradle or a caged pack. This innovative packaging is
color-coded for size and designed to ensure the device is maintained in the
correct flexion prior to use it also acts as a base for lubrication
select the appropriate size i-gel® according to patient weight.
When selecting size it should be remembered that the i-gel® cuff does
look smaller than the corresponding size of many traditional supraglottic Airways
with an inflatable cuff.
Esuring that you conform to local policy for hygiene, open the i-gel®
package and take out the protective cradle or cage pack containing the
device. In the final minute of pre-oxygenation remove the i-gel® and
place a small bolus of a water-based lubricant such as KY jelly onto the
middle of the smooth surface of the cradle or cage back in preparation for
lubrication. Do not use silicone based lubricants. Grasp the i-gel® with the
opposite freehand along the integral bite block and lubricate the back sides
and front of the cuff with a thin layer of lubricant.
This process may be repeated if lubrication is not adequate. After lubrication has been completed
check that no bolus of lubricant remains in the bowl of the cuff or elsewhere on the device.
Avoid touching the cuff of the device with your hands.
Place the i-gel® back into the protective cradle or cage pack in preparation for insertion.
Do not place the device onto the pillow or chest of the patient.
Always use the protective cradle or cage pack.
Do not use unsterile gauze to help in lubricating the device.
Do not apply lubricant too long before insertion.
Always ensure dentures or plates are removed from the mouth before attempting insertion.
The i-gel® must always be separated from the protective cradle or
cage pack prior to use these are not introducers and must never be inserted
into the patient's mouth.
Insertion technique
A proficient user can achieve insertion in less than five seconds.
Remove the eye gel from the protective
cradle or cage pack, grasp the lubricated i-gel® firmly along the integral bite block.
Position the device so that the eye gel cuff outlet is facing towards the chin of the
patient. The patient should be in the sniffing the morning air position with
head extended and neck flexed the chin should be gently pressed down before
proceeding to insert introduce the leading soft tip into the mouth of the
patient in a direction towards the hard palate
glide the device downwards and backwards along the hard palate with a continuous
but gentle push until a definitive resistance is felt
do not apply excessive force on the device during insertion.
It is not necessary to insert fingers or thumbs into the patient's mouth during the process of insertion.
If there is early resistance during insertion a jaw thrust
or insertion with deep rotation is recommended
when inserted to a definitive resistance the tip of the I'd gel should be located
into the upper esophageal opening, and the cuff should be located against
the laryngeal framework. The incisors should be resting on the integral bite block.
The i-gel® has a horizontal line on the integral bite block to indicate the
optimal position of the teeth but the teeth may rest safely anywhere
on the integral bite block.
The i-gel® should then be taped down maxilla to maxilla.
When inserting the eye gel it should be remembered that partial resistance and
then a feeling of give way may sometimes be felt before the endpoint resistance
is met, this is due to the passage of the bowl of the eye gel through the
Faucial pillars. This is quite normal and consistent with correct insertion, but in
such cases insertion needs to continue until definitive resistance is felt.
Let's look at some i-gel® insertions in real patients note the sniffing the morning
air position and the gentle press down on the chin see how there is no need for
fingers to be inserted in the mouth.
There is never a need to apply excessive force or to repeatedly push down on the
device once definitive resistance has been felt.
How to use the gastric channel
If required a nasogastric tube can be
inserted down the gastric channel of the eye gel for a quick and efficient
insertion it is important that the nasogastric tube and the gastric channel
of the i-gel® have been adequately lubricated before insertion is attempted.
The ideal way to achieve this is to place a small bolus of lubricant over
the proximal end of the gastric channel the nasogastric tube should then be
inserted a short way down the channel and moved in and out to prime it before completing insertion.
The maximum size of nasogastric tube that can be inserted
down the i-gel® is size 10 French gauge for a size 1.5, 12 French gauge for a size
2, 2.5, 3, and 4 and a size 14 French gage for a size 5 i-gel®.
In summary i-gel® is a simple and effective alternative to traditional supraglottic airway devices
i-gel® has been designed to eliminate the need for an inflatable cuff and
create a superior anatomical seal mirrored to the pharyngeal laryngeal structures.
It includes a gastric channel to reduce the risk of aspiration and is very easy and rapid to insert.
i-gel® offers natural airway management