Truview EVO2™ Q&A
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Dateline : 18-November-08
Truview Evo Clinical Experience
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Dateline : 10-August-08 "I used the scope today on an extremely obese young woman with BMI of 47. She had a very small mouth and may have been difficult to intubate. She was also in a choir and worried about her voice/throat. I didn't try a conventional scope, but positioned her on a wedge pillow and it was a BREEZE with the TruView EVO. I plan to use it for oral surgery cases on Thursday, all of which will require nasal intubations, so it will be interesting to use with Magill forceps if I need them (I do about 80% of the time)." Dr Barbra Coda MD, Anesthesiologist Springfield, OR USA |
Q&A
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Question: |
Posted 13-May-08
You strongly recommend that the Truview Evo is connected to an oxygen-flow of 10 litres/min and that this will prevent misting and remove secretions during visualization and e-t-tube placement. I have sometimes found myself in operating rooms that do not have a spare central oxygen line. What can I do ? Frank (Guangzhou, China) |
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Answer: |
Posted 14-May-08
You can demist the Truview Evo eyepiece by carefully spraying any “Anti-fog” solution over the Viewtube ends. You can also place the tip of the viewpiece in hot water for 1 minute before use. However, your best choice is to still try and use an appropriate oxygen flow. Once the patient has their oxygen content stabilized using a mask, you can remove the oxygen flow from the mask and connect it to the Truview Evo oxygen port and then use this flow taken from the anaesthesia machine to complete your intubation.
However, sometimes if there is a very old anaesthesia machine being used in the operating room, you will have to create a special connector from a piece of Hudson or similar plastic tubing from some other manufacturer. See the three pictures below and carefully follow the instructions :
How to use a Hudson Tube Connector (3 pictures):
How to make a suitable connector:
Precautions:
Dr Katkade, Mumbai, India |
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Question: |
Posted 15-May-08
If I take give oxygen flow through the Truview Evo, will this be enough to keep my patient’s oxygen level stable ? In some operation rooms in China, we still use oxygen from a gas-cylinder and it worked fine. Frank (Guangzhou, China) |
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Answer: |
Posted 16-May-08
It is normal practice for the anaesthetist to "pre-oxygenate" the patient for 5 minutes in order to fill their lungs to 100% blood oxygen levels and this should provide sufficient oxygen in the blood stream for atleast 5-6 minutes while the patient is in a non-breathing status because of the paralytic drugs that he has been given. The oxygen insufflation that the patient receives through the Truview Evo is extra to his needs and theoretically should slow down any decline in blood oxygen levels that are occurring thereby “extending the window of intubation” up to a certain point. You should not believe that you can use this Truview Evo oxygen flow instead of the oxygen mask since most of the oxygen is escaping around the view-piece lens and is not actually entering the patient’s lungs.
In my experience, in most of the Truview Evo intubations , I have not seen oxygen saturation levels drop below 90% . The only exceptions where cases when the clinician did not pre-oxygenated long enough or where the anaesthetists took longer to intubate because of the patients medical history (cases of asthma or diagnosed pulmonary diseases). In these cases, the clinician just switched the tube back to the oxygen mask and gave more oxygen for a few minutes before continuing with the Truview Evo intubation. Dale ( Senior Anaesthesia Technician, USA) |
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Answer: |
Posted 17-May-08
Further to this discussion , can I add that I have noticed that indirect connection of oxygen sometimes does cause fogging despite the meter reading showing 10 litres per minute flow . It is well known that these meters are inaccurate and that oxygen is lost within the circuit. In my experience a direct connection is always the preferred method.. It is also essential to check that the tubing being used is free of bends and kinks since this can also cause inadequate oxygen supply.
You cannot imagine in how many cases where the anaesthetist maintains that he cannot see because of fogging and insists that he is using and the metre is reading 10 litre per minute , we have determined that a kink in the tube was the real cause of the impeded flow and the consequent fogging.. Joshua , Mumbai |
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Question: |
Posted 21-June-08 How can I make sure that the Premier camera settings have been set properly ? |
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Answer: |
Posted 22-June-08
See table (attached) for correct settings of the Premier camera. If you have any problems, please contact me Evgeny Pecherer technic@truphatek.com |
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Question: |
Posted 04-July-08 Question : “When using a hospital operating room camera head attached to the Truview Evo , how do I gain a larger viewing area ?” |
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Answer: |
Posted 04-July-08
After you have attached the endoscopic camera head to the Truview Evo viewpiece, make sure that the "aperture" opening is adjusted. If you hook up the camera and the aperture is closed you will get a small view but by opening the aperture, you can adjust the view to a much wider range. Dale Karl dale@truphatek.com |
FAQ
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Can the side-port be used for suction ? |
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No it cannot. It is designed only for giving oxygen. When connected to a flow at 8 to 10 litres per minute, the oxygen has a number of important effects. Firstly, it allows insufflation to take place and thereby extends the “window of intubation” removing the “time panic” to complete insertion of the e-t- tube within one minute. As important, this rate of oxygen flow acts as a demister of the lens system and pushes the secretions away keeping the view absolutely clear. You will need these rates of oxygen flow to see the effects. Lower rates do not work so well. There is no fear of over ventilating the patient since most of the gas escapes through the open mouth. |
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The Patient is non-breathing when I intubate so the oxygen port really does not help so how does it give me a window? |
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: I guess that you have pre-oxygenated the patient to 100% levels prior to trying to intubate. Using the oxyport and maintaining the oxygen flow, helps to maintain that level allowing some diffusion of oxygen and replacement of nitrogen volume . However small the effect, it is sufficient to keep the O-2 saturation stable. |
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Do I have to enter the oral cavity midline? |
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Yes, most of the new devices that give you vision require you to enter the device mid line and not enter as if they were standard laryngoscopes. This means that you cannot use the standard right and sweep method. Enter midline and keep the blade midline. As the distal tip of the blade advances toward the uvula continue slowly towards the epiglottis. When you see the epiglottis, lift the blade tip very slightly to visualize the vocal cords. |
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What advantages does the Truview EVO offer over other indirect laryngoscopes? |
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The Truview Evo has some very unique features. The 42 degree blade angle(anterior and lateral) offers a wider view and provides less lifting force thereby preventing tissue trauma and allowing entry into small mouthed patients.
It substantially reduces the possibility of injury in patients wearing cervical collars as it is unnecessary to utilize the “sniff position” as you would in standard laryngoscopy.
The Truview EVO offers a whole range of visual options. It can be used very effectively with just its own lens system or it can be easily connected to an OR endoscopic camera head (to visualize procedure on a monitor). It is very simple to use and very portable so that you can run with in your pocket to other areas of the hospital. It will fit easily onto crash carts, difficult airway carts and OR anesthesia carts. Its design and attributes make it the most affordable device compared to all other such devices. It just makes sense. |
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What type of learning curve is there to this device? |
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All new devices require practice with moderate learning curve to get the technique right and to get the feel of the blade. Remember to always:
a) Start midline and keep blade midline.
b) While viewing through the lens, advance the e-t-tube on the right side of the blade slowly (and this needs to be emphasized..slowly) . By doing this, you will see the tube entering into the view of the distal prism. As soon as you see the tip of the tube, stop . Then advance the e-t-tube tip toward the cords. As soon as you start to enter the cords tilt (rotate) the tube upwards (it may be necessary to begin to remove the stylet at this time) and then advance it into and through the cords.
Most clinicians master the required technique within a couple of intubations. |
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How is the Truview cleaned? |
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Remove the optical viewing tube and send it for Sterrad sterilization. It must be put in the cycle that has a maximum temperature of 60 degrees Centigrade (equivalent to 140 F). All other parts of the blade can be sterilized using autoclave or Sterrad or in any other methodology that is available. The handle can be wiped with a disinfectant or treated as per protocol. |
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For more information, please contact Dale Karl:
LPN, Anesthesia Technician
Clinical Support Manager, Truphatek International Limited, 201 N 4th St. Canton, Mo 63435, USA O) 573-288-0070 M) 573-822-4681 e-mail : dale@truphatek.com
Or contact us Here | |
