Gel Insertion

For use in respiratory failure without the presence of a gag reflex. Always used in conjunction with a Bag Valve Mask (BVM).

1. Confirming the gag reflex is not present with the use of an OPA or by simply attempting the i-Gel.
2. Pre-oxygenate using BVM and adjuncts while device is being prepared– this process increases the amount of oxygen circulating in the blood and gives us a reservoir of oxyhemoglobin and “buys” us time while we are inserting the airway device and not breathing for the patient.
3. When choosing the proper size i-Gel, assess the patient for their “ideal” body weight. Ex: 6’ male ideal body weight is ~160 lb. = 70 kg. See i-Gel for Kg weight.
4. Lubricate the distal tip with water-based lubricant.
   1. Do not apply lubricant to the sealing surface of the i-Gel.
5. Remove the OPA if present.
6. Grasp the patient’s tongue and lower jaw with your hand and open mouth by pulling forward.
7. Insert i-Gel with the opening facing up.
8. The distal tip of the i-Gel will “seat itself.” You will see a bulging of the soft tissues in the neck like a “bullfrog” when the i-Gel is inserted to its proper depth.
9. Look to see that the teeth are at the bite block of the device and do not let go of the device until it is properly secured to the face.
10. Be aware that it may take a few minutes for the i-Gel to get warm enough in the airway for a complete seal. Best practice is to have one person holding i-Gel until it is well seated/remaining in place while another responder is giving breaths (step 8) and confirming correct placement (step 9).
11. Attach BVM and deliver breaths.
12. Assess proper placement by using a stethoscope and auscultating for the presence of lung sounds as well as the absence of epigastric sounds.
13. Capnography is always recommended with any supraglottic airway device.
14. Additional confirmation needed – increase in SpO2, improvement in skin color, presence of good chest rise.
15. Ongoing assessment is needed with every ventilation. Whichever team member is assigned to the BVM needs to continually assess for effectiveness of ventilations.
16. If gag reflex returns and/or vomiting begins, immediately turn the patient onto their side, remove the device and suction as needed.
    1. Return to BVM with a mask when airway is clear.