Simple principles:

Left-sided DLT: less likely to be malpositioned (obstruct RUL)
Right-sided DLT: easier to insert, necessary if proximal left main bronchus is occluded

Stylet in bronchial lumen
Remove stylet once tip is through the cords
Left-sided DLT: rotate to the left. Right-sided DLT rotate to the right

Checking – Clinically

1. Treat as single lumen tube. Inflate tracheal cuff and check for equal air entry, normal compliance, no leak

2. Test bronchial lumen. Clamp tracheal limb of catheter mount. Open port to feel leak diasappear. While ventilating inflate bronchial cuff (2ml) until leak disappears. Single lung should ventilate.

3. Test isolated ventilation of contra-lateral lung. Clamp bronchial limb and open port. Opposite lumb should ventilate.

Checking – Bronchoscope

1. Tracheal lumen. Observe bronchial cuff just distal to carina in proximal main bronchus

2. Bronchial cuff. Observe correct placment of Murphy’s eye at RUL orifice.


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