I have had a few questions lately about the "gum elastic bougie". I’m very pleased that this simple yet highly effective adjunct for difficult intubation is finally gaining popularity. The earliest versions of this thin endotracheal tube "guide" were made of gum elastic (latex) coated wire. It was basically a malleable "stick", a little more than double the length of an ET tube. Only one version still contains any latex gum anymore, since most are now latex-free plastic. But first, what is a Bougie?
The definition of Bougie: “A thin cylinder of rubber, plastic, metal or another material that a physician inserts into or though a body passageway, such as the esophagus, to diagnose or treat a condition. A bougie may be used to widen a passageway, guide another instrument into a passageway, or dislodge an object.” One of the most common uses of the term in medicine refers to a weighted esophageal dilator.
Introducer is probably a more accurate description. You put the narrow bougie (introducer) in first when confronted with a difficult intubation, and then send the ET tube down over the long stylet. An even better technique is to pre-load the introducer in the ET tube, holding them together in your right hand. That way you are not fumbling when trying to hold the introducer while feeding the tube down over the top.
Another name this type device can go by is ET Tube Changer. RT’s have been using these for years to permit changing an old tube, or one with a bad cuff for a new one, without needing to perform laryngoscopy. You just slide down the "changer", and pull out the old tube while leaving the changer in position. Then you slide the new one on to the previously noted depth. But the length and diameter of these tube changers and introducer’s and bougies are all nearly the same. So by whatever name, for our practical purposes in EMS they remain the same.
The first time I saw one about ten years ago, it was in the back pocket of an anesthesiologist at Shock Trauma in Baltimore. When I asked what it was he explained it and shared that he had not performed a surgical airway since starting to use it. That really got my attention, and after trying it once I was hooked.
The nice thing about this device is the ease of learning & skill retention. The problem with many alternate airway techniques is that they are very different from your normal intubation technique.With a bougie, you are still using the same basic technique as normal. Scope in left hand, tube in right, passed under direct visualization. That makes it easier to learn and retain the skill, even when used infrequently.There are several different bougies available.
My favorites are the #JEM370 from Instrumentation Industries, and the SunMed #9-0212-70. Either is stiff enough to enhance control. One of the two available SunMed models has a “bent” or coude tip, which allows you to feel the movement of the stylet tip against the tracheal rings during insertion. This is the least expensive alternate or backup airway adjunct on the market. It can help you secure a definitive airway under the toughest field conditions. These devices are less than 10 bucks each. Bang for the buck wise, this is a great value for what it can do in a pinch.