1
with the patient’s head in a neutral position, the lower jaw and tongue are lifted by one hand, the tongue is pressed forwards

during insertion, the tongue should be pressed out of the way with the help of the deeply inserted thumb

2

the Urtubia maneuver is always useful for blind insertion: the Combitube is held bent between

the balloons for a few seconds to facilitate insertion

3

the tube is inserted in a curved downward very “flat” movement

4

ETC can be inserted orally either blindly or with a laryngoscope

5  the tube is inserted until the printed ringmarks lie between the teeth or alveolar ridges

6  first, the oropharyngeal balloon is inflated with 85 ml (Combitube 37 F) or 100 ml (41 F)

7  then, the distal balloon is inflated with 5 to 12 ml (Combitube 37 F); 5 to 15 ml (41 F) 

8  there is a high probability that the tube will be placed in the esophagus

test ventilation is recommended via the longer blue tube No. 1

air passes through the longer tube, leading to the esophageal lumen, into the pharynx and from there over the epiglottis into the trachea since mouth, nose and esophagus are blocked by the balloons

auscultation of breath sounds in the absence of gastric insufflation confirms adequate ventilation when the Combitube

is in the esophagus

9 when no breath sounds are heard over the lungs in the presence of gastric insufflation, the Combitube has been placed into the trachea

ventilation is changed to the shorter clear tube No. 2, leading to the tracheal lumen

now, air flows directly into the trachea