Select the correct KING LT-D size based on patient height. The size is printed on the package and on the tube. Just remember “4 5-6” means size 4 for 5 to 6 feet. “5-6” means size 5 for 6 feet plus. Other sizes are available and may be used in the future.
Test cuff and inflation system for leaks by injecting the maximum recommended volume of air into the cuffs (size 4 - 80 ml; size 5 - 90 ml). Remove all air from both cuffs prior to insertion. The inflation volume is printed on the tube.
Apply lubricant to the beveled distal tip and posterior aspect of the tube, be careful that you don’t get lubricant into the ventilation openings.
Pre-oxygenate as you would for a normal intubation.
The ideal head position for insertion of the KING LT-D is the “sniffing position”. However, the angle and shortness of the tube also allows it to be inserted with the head in a neutral position.
Hold the KING LT-D at the connector with your dominant hand. hold mouth open and apply chin lift with your other hand.
Rotate the King Airway laterally 45-90 degrees so that the blue orientation line is touching the corner of the mouth. Introduce the tip into mouth and advance the airway behind the base of the tongue.
As tube tip passes under the tongue, rotate the tube back to midline (blue orientation line facing chin).
Without exerting excessive force, advance tube until base of connector is aligned with teeth or gums.
Using the syringe provided, inflate the cuffs of the KING LT-D with the appropriate volume: Size 4 70 ml Size 5 80 ml Inflation volume is printed on the tube.
Attach BVM to the KING LT-D. While gently bagging the patient to assess ventilation, simultaneously withdraw the KING LT-D until ventilation is easy and free flowing (large tidal volume with minimal airway pressure).
Depth markings are provided at the which indicate the distance from the distal ventilatory openings. When properly placed, with the distal tip and cuff in the upper esophagus, and the ventilatory openings aligned with the opening to the larynx, the depth markings give an indication of the distance, in centimeters, from the vocal cords to the teeth.
Confirm proper position by auscultation, chest movement and verification with colormetric CO2 detector.
Re-adjust cuff inflation to "just sealed" volume (inflation amount needed to seal the airway at the peak bagging pressure employed).
Secure KING LT-D to patient using tape or other accepted means. A bite block can also be used, if desired.
The KING LT-D is not an ET tube and can’t be used as a med route. The end of the KING airway should be in the esophagus, not the trachea; it therefore will not deliver meds into the lungs! NO MEDS DOWN THIS TUBE!
The LT-D model of the King Airway has a “ramp” at the distal end of the ventilation tube. This ramp is designed for the placement of a guidewire down the tube and into the trachea. The ramp points the guide wire into the trachea. When the guide wire is placed, the King can be removed, leaving the guide wire in place and an ET tube inserted over the wire into the trachea. Initially we won’t be using the guide wires, but the ER folks will.