skip to main content

Double-Lumen Tube Positioning — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCardiothoracic AnaesthesiaDouble-Lumen Tube PositioningFRCA Final

A 58-year-old woman undergoes a right thoracotomy for lung resection using a left-sided 37 Fr double-lumen tube. After she is positioned in the left lateral decubitus position, the bronchial cuff is deflated and flexible bronchoscopy through the tracheal lumen shows that the proximal edge of the bronchial cuff lies above the carina. What is the most appropriate action?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Advance the DLT under fibreoptic guidance until the bronchial cuff lies just below the carina

The correct answer is C. A bronchial cuff lying above the carina indicates proximal migration of the left-sided DLT during lateral positioning. With the cuff deflated, the tube should be advanced under continuous fibreoptic guidance until the proximal cuff margin lies just below the carina within the left main bronchus. Position should then be checked through both lumens, confirming unobstructed right-sided bronchi and patent left upper- and lower-lobe bronchi. Withdrawal would worsen the displacement. Inflating the cuff while it is partly tracheal risks cuff herniation, airway trauma and ineffective lung isolation. Conversion to a bronchial blocker or single-lumen tube is unnecessary when an otherwise suitable DLT can be repositioned.

Reference: Russell WJ et al. A novel combined approach to placement of a double lumen endobronchial tube using a video laryngoscope and fiberoptic bronchoscope: a retrospective chart review. 2024. https://pubmed.ncbi.nlm.nih.gov/38609865/