Page 187 - 2023 SMOG Digital

BLIND INSERTION AIRWAY

DEVICE (BIAD)

CLINICAL INDICATIONS:
Patient with inadequate respiratory drive or respiratory failure due to any reason (e.g., altered mental status,
trauma, infection) other than airway burns, anaphylaxis, or other causes of airway swelling / obstruction.
CONTRAINDICATIONS:
• Massive upper airway trauma distorting anatomy
• Penetrating neck trauma
PROCEDURE:
Consider paralytic/analgesia/sedation medications when placing supraglotic airways devices. In any
instance of BIAD placement, caregiver must be prepared for vomiting and aspiration.
• Prepare, position, and pre-oxygenate the patient with 100% O2. Ensure patient on monitor if possible.
• Select appropriate size BIAD and ensure proper cuff inflation / deflation.
WARNING: BIADs may not
• Lubricate with water-soluble jelly. prevent or block aspiration of
• Advance tube towards posterior pharynx until seated in correct position. gastric contents.
• Inflate balloon as per package insert and attempt to ventilate with BVM.
• If good airflow / chest rise / PO2, secure device in place and ventilate patient with BVM / Vent.
• If unable to ventilate / resistance, leave first BIAD in place, deflate balloon, and pass a second BIAD in
the same manner as the first (second should only be able to enter the trachea as the first may have
entered into the esophagus approx 5-10%). Once second BAID is in place, remove first and inflate the
cuff on the second device. Attempt to bag as above. If successful, ventilate patient.
Document procedure, results, and vital signs.

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