Question about Combitube

[Guardian]

I probably should know this, i guess i forgot. Why are combitubes not packaged as sterile like ET tubes. We don't use them more than once.

[Ridryder911]

Actually most ET tubes or combitubes are not sterile because anything entering the mouth will be considered becoming unsterile and does not have to be sterile. That is why largynoscopes are not sterile and airways such as oral etc are not as well... Now, after you have intubated into the lung (not esophagus) anything going into that should be sterile (i.e suction cath, etc.) If however if it is in the esophagus, it again does not have to be sterile, rather aseptic clean...

R/r 911

[MMiz]

Actually most ET tubes or combitubes are not sterile because anything entering the mouth will be considered becoming unsterile and does not have to be sterile. That is why largynoscopes are not sterile and airways such as oral etc are not as well... Now, after you have intubated into the lung (not esophagus) anything going into that should be sterile (i.e suction cath, etc.) If however if it is in the esophagus, it again does not have to be sterile, rather aseptic clean...

R/r 911
Great information! This is a question I've actually had since I started EMS, but never asked because I didn't want to get anyone in trouble.

Thanks for the info!

[Guardian]

why do they package et tubes as sterile?

[Ridryder911]

Because, if the tube is used for a "trach" tube (does not enter orophaynx) it can be a sterile procedure. Again, anything going through the oral/nasal pharynx is immediately exposed as "non-sterile".. that is why one should not suction tracheal secretions with the same catheter as the oral one. Cross contamination. Ever notice that in text, one can "prepare the equipment" and lay it down. If it was truly sterile, one would have to place it on a sterile towel...etc.

There are a lot things that are "sterilized" so while working in a sterile field one can handle it as well.. light handles, even used sterile rubber bands (for ortho), etc.. When you are in "sterile field" you are to hold hands up above waist (yes like t.v., anything below waist line is considered unsterile as well as a sterile field a 3 feet around equipment etc.. not to walk near etc.. General principles of aseptic care...

R/r 911

[Guardian]

Because, if the tube is used for a "trach" tube (does not enter orophaynx) it can be a sterile procedure. Again, anything going through the oral/nasal pharynx is immediately exposed as "non-sterile".. that is why one should not suction tracheal secretions with the same catheter as the oral one. Cross contamination. Ever notice that in text, one can "prepare the equipment" and lay it down. If it was truly sterile, one would have to place it on a sterile towel...etc.

There are a lot things that are "sterilized" so while working in a sterile field one can handle it as well.. light handles, even used sterile rubber bands (for ortho), etc.. When you are in "sterile field" you are to hold hands up above waist (yes like t.v., anything below waist line is considered unsterile as well as a sterile field a 3 feet around equipment etc.. not to walk near etc.. General principles of aseptic care...

R/r 911


Endotracheal tubes reach below the level of laryngopharynx, to do this, they have to go through the oropharynx just like combitubes and OPAs. Also, we were told only to lay down the ET tube onto it's sterile package to maintain sterility. I agree that it is impossible to maintain a true sterile environment in the field. We just have to do the best we can. My question is, why do they package ET tubes into sterile packaging but do not package combitubes into sterile packaging because both et tubes and combitubes have the potential for ending up in the trachea.

[Flight-LP]

To always lay the ETT down in its own packaging is just not practical given the different circumstances and conditions in which we intubate. The tube itself is not sterile and was never intended to be. The inner aspect of the tube is to remain sterile so that sterile items can be inserted into it. Same with the Combitube. Besides, when is the last time you actually dropped a Combitube into the trachea? That is a feat all in its self.....................

[Guardian]

To always lay the ETT down in its own packaging is just not practical given the different circumstances and conditions in which we intubate. The tube itself is not sterile and was never intended to be. The inner aspect of the tube is to remain sterile so that sterile items can be inserted into it. Same with the Combitube. Besides, when is the last time you actually dropped a Combitube into the trachea? That is a feat all in its self.....................

ET tubes are advertised as sterile in package. Combitubes are not and some have slits in the packaging

[Ridryder911]

Again, intubation is not a "sterile" procedure. There is a large difference from sterile procedure and aseptic one. Again, once the tube is placed through the oropharynx it is not sterile.

The reason for packaging the ETT in a sterile container is because again, they may be used for tracheal tubes without entering oropharynx (yes surgical openings), as well as was described the inside of the lumen (the main reason for being as aseptic as possible) is the direct route of entrance into the pulmonary system. Med's, tubes, etc. is a direct route into the pulmonary tree.

Again, there are a lot of things that are sterilized for patient protection, yet are not considered or used as a sterile procedure. Again, don't confuse sterile products with the intent or use of the products.

R/r 911

[Wingnut]

WOW great post, Thanks Rid, I didn't know any of that.

[Guardian]

Again, intubation is not a "sterile" procedure. There is a large difference from sterile procedure and aseptic one. Again, once the tube is placed through the oropharynx it is not sterile.

The reason for packaging the ETT in a sterile container is because again, they may be used for tracheal tubes without entering oropharynx (yes surgical openings), as well as was described the inside of the lumen (the main reason for being as aseptic as possible) is the direct route of entrance into the pulmonary system. Med's, tubes, etc. is a direct route into the pulmonary tree.

Again, there are a lot of things that are sterilized for patient protection, yet are not considered or used as a sterile procedure. Again, don't confuse sterile products with the intent or use of the products.

R/r 911



when you said "trach" earlier, I didn't know you were talking about surgical trachs. Anyways, thanks for clarifying, it finally does make some sense to me now.

[Guardian]

besides trachs and chest tubes, what other surgical procedures can you use ETT's for?

[Flight-LP]

Why would you use an ETT as a chest tube? If it is within your scope of practice to perform tube thoracostomies, then why not just use a chest tube and do it right????