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Bronchial Blockers

Bailey Freeman, DNP, CRNA and Angela Mordecai

Quick Facts
Procedure
Confirmation Steps
Documentation Requirements
Scope Guide

Quick Facts

  • A bronchial blocker (BB) is a catheter with a balloon that is inserted through a standard endotracheal tube (ETT).

 

  • The balloon can be inflated in either the left or right mainstem bronchus to achieve lung isolation.

 

  • A BB can be used to isolate specific lobes when it is positioned in distal airways.

 

  • Must use fiberoptic bronchoscope for placement.

 

Indications

Lung isolation methods optimize surgical access while maintaining one-lung ventilation (OLV):

  • Provide motionless, accessible operative field.
  • Prevent contralateral lung contamination from hemorrhagic/purulent material.
  • Enable differential lung ventilation.

Specific Use Cases:

  • Difficult airway requiring awake oro/nasotracheal intubation and OLV.
  • Existing endotracheal/tracheostomy tube requiring OLV.
  • Cases requiring postoperative mechanical ventilation (a DLT is not appropriate for postoperative mechanical ventilation).

Contraindications

  • Cases requiring rapid lung isolation.
  • Situations where DLT may be more appropriate.

Procedure

Equipment Needed:

  1. Appropriately sized Bronchial Blocker.
  2. Test balloon inflation/deflation and lubricate BB before insertion.
  3. Standard single-lumen ETT (7.5-8.0 mm ID for adults).
  4. Flexible fiberoptic bronchoscope.
  5. Multiport adapter (usually comes in BB package; attach to ETT).
  6. Back-up airway equipment.

Technique

For left-sided placement, rotate head toward right to align left mainstem bronchus.

  1. Establish endotracheal intubation.
  2. Attach multiport adapter.
  3. Perform initial bronchoscopy (verify 3-4 cm between ETT tip and carina).
  4. Guide BB into position under bronchoscopic visualization.
  5. Position BB 5-10 mm below carina.
  6. Test position with balloon inflation (5-8 mL air for adults).

OLV Initiation with a Bronchial Blocker in Place

  1. Administer 100% oxygen.
  2. Confirm BB position bronchoscopically.
  3. Stop positive pressure ventilation.
  4. Disconnect circuit and allow expiration.
  5. Inflate BB balloon under visualization.
  6. Apply intermittent suction.
  7. Resume ventilation on nonoperative side.

Confirmation Steps

  • Verify BB exits ETT’s distal opening (not Murphy eye).
  • Confirm proper balloon inflation (5-8 mL for most adult BBs).
  • Reconfirm position after patient repositioning.
  • Verify position in lateral decubitus position.

The clinician should also confirm:

  • Adequate ventilation and isolation.
  • Surgical field feedback.

Documentation Requirements

  • BB type and size used.
  • ETT size.
  • Confirmation of position.
  • Balloon inflation volume.
  • Any complications.

SCOPE GUIDE

Strategies

Size Selection/Considerations

  • Arndt® 7Fr: Use with 7.5mm ID ETT.
  • Arndt® 9Fr: Use with 8.0mm ID ETT.
  • Cohen® 9Fr: Use with 8.0mm ID ETT.
  • EZ-Blocker® 7Fr: Use with 7.5-8.0mm ID ETT.

Device-Specific Notes:

  • Arndt®: Remove wire guide after positioning.
  • Cohen®: Use wheel-turning device for tip deflection.
  • Uniblocker®: Hockey stick shape aids positioning.
  • EZ-Blocker®: Y-shaped design seats on carina.

Clinical Optimization

Troubleshooting

  • Dislodgment: Reconfirm position frequently, secure fixation, and ensure careful patient positioning.
  • Inadequate seal: Adjust balloon inflation, check position relative to carina, verify appropriate size selection.
  • Difficult placement: Use specific BB features, consider alternative BB type, ensure proper lubrication.

Patient Management

  • Frequent position reconfirmation prevents dislodgment.
  • Adjust balloon inflation volume for optimal seal.
  • Utilize device-specific features for placement.
  • Monitor position during patient movement.
  • Address any hypoxia immediately when detected.
  • Maintain clear, ongoing communication with the surgical team.

Quick Resources

The Cohen® flexitip bronchial blocker with a multiport connector. The blocker is inserted through a single-lumen endotracheal tube, with tip deflection and guidance into a mainstem bronchus under fiberoptic bronchoscopy. The wheel-turning mechanism allows controlled tip navigation.
Source: Campos JH, 2019. Reproduced with permission from Campos JH. Lung Isolation. In: Slinger P (ed). Principles and Practice of Anesthesia for Thoracic Surgery. Springer Nature Switzerland AG; 2019. [DOI: 10.1007/978-3-030-00859-8_16].

 

 

 

a) Placement of an Arndt® blocker through a single-lumen endotracheal tube with the fiberoptic bronchoscope advanced through the guide wire loop.
(b) Optimal position of a bronchial blocker in the right or left mainstem bronchus as seen with a fiberoptic bronchoscope.
(A) Right mainstem blocker; (B) Left mainstem blocker.
Source: Campos JH, 2019. Reproduced with permission from Campos JH. Lung Isolation. In: Slinger P (ed). Principles and Practice of Anesthesia for Thoracic Surgery. Springer Nature Switzerland AG; 2019. [DOI: 10.1007/978-3-030-00859-8_16].

 

References

This work adapts content from FOAMed Medical Education Resources by LITFL (Life in the Fast Lane), licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. The original work can be found at https://litfl.com.

  1. Nickson C. Selective Lung Ventilation. Life in the Fast Lane. Published July 5, 2024. Accessed January 28, 2025. https://litfl.com/selective-lung-ventilation/
  2. Life in the Fast Lane. Double-lumen Endotracheal Tube (DLT). Published 2020. Updated 2024. Accessed January 28, 2025. https://litfl.com/double-lumen-endotracheal-tube-dlt/
  3. Campos JH. Separation of the lung: Double-lumen endotracheal tubes and endobronchial blocker. In: Cohen E (ed). Cohen’s Comprehensive Thoracic Anesthesia. 1st edition. Philadelphia, PA. Elsevier. 2022: 213-39.
  4. Campos JH. Lung isolation in patients with a difficult airway in thoracic anesthesia. In: Cohen E (ed). Cohen’s Comprehensive Thoracic Anesthesia. 1st edition. Philadelphia, PA. Elsevier. 2022: 240-8.
  5. Campos J. Lung isolation. In: Slinger P (ed). Principles and Practice of Anesthesia for Thoracic Surgery. 2nd edition. Switzerland. Springer Nature. 2019: 283-309.
  6. Campos JH. Which device should be considered the best for lung isolation: Double-lumen endotracheal tube versus bronchial blockers. Curr Opin Anaesthesiol. 2007; 20:27-31.
  7. Campos JH, Musselman ED, Hanada S, Ueda K. Lung isolation techniques in patients with early stage or long-term tracheostomy: A case series report of 70 cases and recommendations. J Cardiothorac Vasc Anesth. 2019; 33: 433-9.

Media Attributions

  • The-Cohen-flexitip-bronchial-blocker-with-a-multiport-connector-90 © Campos JH, 2019. Reproduced with permission from Campos JH. Lung Isolation. In: Slinger P (ed). Principles and Practice of Anesthesia for Thoracic Surgery. Springer Nature Switzerland AG; 2019. [DOI: 10.1007/978-3-030-00859-8_16].
  • a-Placement-of-an-Arndt-R-blocker-through-a-single-lumen-endotracheal-tube-with-the © Campos JH, 2019. Reproduced with permission from Campos JH. Lung Isolation. In: Slinger P (ed). Principles and Practice of Anesthesia for Thoracic Surgery. Springer Nature Switzerland AG; 2019. [DOI: 10.1007/978-3-030-00859-8_16].

License

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The Scope Copyright © by Bailey Freeman, DNP, CRNA and Angela Mordecai is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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