This week, I wanted to touch a bit on Meconium Aspirators as apart of our GI Bleed intubation tool kit. At some point during second year, many of my fellow classmates and I started throwing these into airway boxes at Elmhurst. Especially in cardiac/resus, I think knowing to reach for one when you need one is critical, though I don’t think they need to be in every airway box.
First, before I get into the specifics of meconium aspirators, here are a couple good reviews of intubation in UGIB. Rising PGY-2’s, as you start cardiac/resus, you should know this through-and-through. When a severe UGIB comes at you with an airway full of blood, they come at you fast, and you have to be prepared. **Ask your attendings if they want you to start VL or DL.
https://litfl.com/intubation-in-upper-gastrointestinal-haemorrhage/
https://www.emdocs.net/intubating-the-gastrointestinal-bleeder/
The meconium aspirator allows you to attach the suction tubing directly to your ETT to facilitate large bore suctioning of the airway as you advance the ETT. Note that the attached meconium aspirator precludes you from using a stylet to intubate, so you have to be facile with ETT manipulation for successful tube delivery. You will not have anything in place to keep that ETT from kinking and bending in every place you don’t want it to. There is such a thing as a swivel adaptor that allows both a stylet and use of the aspirator, but as far as I can tell, we don’t have this in our bays.
Most of the attendings I’ve spoken to have either never actually used this or have used it very infrequently. Most of them noted that a 2-suction setup lodged into the airway with the help of assistants have allowed them to intubate with a decent enough view. They also noted that using the meconium aspirator on attempt 1 limits a junior from being able to intubate as easily without a stylet and increases the risk of the attending/senior (rightfully) taking the airway.
Definitely know exactly where they are. Throw one into the C-MAC at the start of your shift. Throw one into your pocket fast if you see a GIB rush through your cardiac/resus doors. This could save you and your patient’s life, but probably doesn’t need to be in every airway box.
** This pearl stimulated interesting conversation amongst our attendings via email chain. I think the ultimate conclusion was that between the double yankauer suction catheter setup, use of the Ducanto suction catheter, and the SALAD technique, the meconium aspirator is probably unnecessary to have in our GIB tool kit.
