The traffic light bougie: a study of a novel safety modification

Abstract

SummaryUse of a bougie is not without risk, and insertion too far may cause airway injury. We designed a new bougie with a 'traffic light' system to indicate depth of insertion. Forty anaesthetists were randomly assigned to insert either a conventional single-coloured bougie or a novel traffic light bougie. Depth of insertion was measured before and after railroading a tracheal tube. Participants were not informed as to the purpose of the colouring system. The median (IQR [range]) insertion depth of the traffic light bougie was 22 (21-24 [19-27]) cm and for the conventional bougie was 28 (21-32 [20-35]) cm (p = 0.011). Median (IQR [range]) insertion depth after railroading for the traffic light bougie was 25 (25-28 [21-34]) cm and for the conventional bougie was 30.5 (27-35 [23-40]) cm (p = 0.003). This simple colouring system appears to allow intuitive use and significantly reduced the depth of bougie insertion. This system could be also used with other airway exchange devices to improve safety.

Bougie-associated bronchial injury complicated by a nephropleural fistula after percutaneous nephrolithotomy: a tale of two complications

“…The accidental advancement into smaller airway must be avoided by asking an assistant to hold it during the railroading 13. Innovations like traffic signal bougie may further be of benefit in preventing airway trauma 14. In addition, the diagnosis of nephropleural fistula should be kept in mind following delayed development of respiratory complications like pleuritic pain associated with pleural effusion in a patient with post-PCNL.…”

Bougie insertion – the perils of 'click' and 'hold‐up' signs

“…Following recent incidents and warnings on the dangers of residual anaesthetic drugs in intravenous lines [1,2], saline flushing of intravenous connectors has been advocated to avoid the danger [3,4]. However, we would like to draw attention to a problem that may leave residual drugs within multilumen connectors despite proper precautions.…”

“…Despite newer developments such as the traffic light bougie [4], it appears that both the click and hold-up signs will continue to be taught to future generations of anaesthetists, and for this reason, it would seem essential that instruction is also provided about the dangers and fallibility associated with these signs. …”

Videolaryngoscopy in real patients – a welcome change

“…Wallace et al's study raises questions about the benefits of videolaryngoscopes with a McGrath blade, it being clearly more difficult to get as good a laryngeal view using the McGrath compared with using it either as an indirect videolaryngoscope or using a standard Macintosh laryngoscope, and requiring more force and more airway adjuncts to be used, both of which could cause patient injury [5]. I was interested that the authors required fewer airway adjuncts when using the McGrath blade as a videolaryngoscope, as use of adjuncts -such as a stylet or bougie -are recommended as routine [6], although this may suggest that participants' trachea were particularly easy to intubate or, more likely, that operators were highly experienced [7].…”

“…With the patient in a lateral decubitus position, a curvilinear ultrasound transducer (2-5 MHz) directed cranially, 6-8 cm lateral to the spinous process of L1 and angled medially, identifies the QL muscle as it tapers cranially before its insertion into 12th rib. The lateral free border of the QL muscle widens laterally to extend beyond the lateral margin of the paraspinal muscles at L2, at which 'crossover point' [5], a block needle can be advanced in a cephalad direction, through the latissimus dorsi and QL muscles, before injecting local anaesthetic anterior to the QL between the QL muscle and the anterior layer of the thoracolumbar fascia, observing spread in cephalad direction close to the 12th rib with Figure 2 Sagittal section of the fascial relations of fascia transversalis and subendothoracic fascia with the trajectory of needle and medication spread in a cranial direction posterior to the fascia transversalis and endothoracic fascia.…”