Inside the double lumen tube
Aug 06, 2026
One-lung ventilation is a technique that can seem complex until you understand what is happening inside the double-lumen tube (DLT). For perianaesthesia nurses, recognising how a DLT functions and the equipment needed to support its use helps build confidence when caring for patients undergoing thoracic surgery.
Unlike a standard endotracheal tube, a DLT has two separate lumens that allow each lung to be ventilated independently. This enables the anaesthetist to isolate one lung while the other continues to receive ventilation, providing the surgical team with the exposure required during many thoracic procedures. Left-sided DLTs are most commonly used because they are generally easier to position, while right-sided DLTs are reserved for specific clinical situations and require greater precision due to the anatomy of the right upper lobe.
Successful lung isolation depends on more than selecting the correct tube. Fibreoptic bronchoscopy is considered essential for confirming accurate placement and should be repeated after the patient is repositioned, as movement can lead to tube displacement.
🔹 Double-lumen tubes allow independent ventilation of each lung.
🔹 Fibreoptic bronchoscopy is the gold standard for confirming correct tube placement.
🔹 Both tracheal and bronchial cuffs should be checked before insertion.
🔹 Equipment should include an appropriately sized DLT, functioning fibreoptic bronchoscope, suction, lubrication, cuff syringe and connectors.
🔹 Tube position should always be reassessed after lateral positioning.
For perianaesthesia nurses, understanding how the DLT works also supports safe postoperative care. Awareness of the airway device used, potential airway oedema, lung re-expansion and communication with the anaesthetic team all contribute to continuity of care.
A sound understanding of the DLT, combined with the right equipment and careful verification of placement, helps create safer airway management and better outcomes for patients requiring one-lung ventilation.
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References
Foley, K.A. & Slinger, P. (2011). Fibreoptic bronchoscopic positioning of double-lumen tubes. Anaesthesia and Intensive Care Medicine, 12(12), 554-557.
Sazak, H., Göktaş, U., Alagöz, A., Demirbaş, Ç.S., Güven, Ö. & Şavkılıoğlu, E. (2012). Comparison of two different right-sided double-lumen tubes with different designs. Turkish Journal of Medical Sciences, 42(6), 1063-1069.
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