Glidescope help

[Intubate]

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So my hospital has recently purchased a glidescope... I've used it maybe 10 times for routine airways and have had a perfect or nearly perfect view every time. Two or three times though, despite the perfect view, I have been unable to put the tube in the hole. It seems like it should be easy to manipulate it , but there's just so little room that it doesnt happen. What am I doing wrong?

As an aside, we also trialed the Pextax AWS which seems to get around this problem by preloading the tube. Anyone use this device?

Thanks.

 

[fastosprintini]

make sure you pass the tube coming from the side , not ap as you would with a mac blade , it uses the limited space better...
imho, the bullard is still better.
fasto

 

[drRumi]

likely you're going in too far. this seems to be the most common problem with using the glidescope. every time i use the glidescope and cant get a good view and/or dont have enough room, i withdraw the scope just a touch. this way you still get a pretty good view, and have enough room to slide in the tube.

 

[urge]

Are you using the glidescope stylet?

 

[bullard]

I agree with the withdrawing the scope suggestion. If you're still having issues, consider placing a bougie first and then tube over that.

 

[Intubate]

Are you using the glidescope stylet?

Yes.

 

[2win]

likely you're going in too far. this seems to be the most common problem with using the glidescope. every time i use the glidescope and cant get a good view and/or dont have enough room, i withdraw the scope just a touch. this way you still get a pretty good view, and have enough room to slide in the tube.

Ditto. Don't do the hyperextension either.

 

[monchi]

Withdrawing a little can be a good move (for so many things)
When making adjustments, rotating the styletted ETT is usually the way to go. Sometime you just get the tip of the ETT in, but can't pass, then you push to ETT forward off the stylette to advance the ETT.
Also lifting the glidescope will give you more room.
There's a learning curve - after a few more intubations, it will be easy.
I've had a few really tough airways that I didn't want to do awake, and for those I used the glidescope with the fiberoptic. It was nice to have that option.

 

[inmyslumber]

When you have a good view (vocal cord and opening midline), carefully advance the ETT with glidescope stylet just at the base of the opening but do not pass the ETT/ stylet through.
At that point, remove the stylet (should be possible with your right thumb) and slightly advance the ETT(with the rest of your right hand). The ETT should slide "up and into"into the opening. The stylet does not enter through the vocal cord opening at all.

I have had excellent results with this technique. Hope this helps.

 

[drRumi]

oh and also, if you feel the tip of the ETT is too low and you cant seem to get it to point up just a tad to glide in past the cords, using your right thumb lift the handle on the stylet. this points the tip of your ETT up and you can in essence raise the ETT and through the cords. good luck.

 

[Jeff05]

When you have a good view (vocal cord and opening midline), carefully advance the ETT with glidescope stylet just at the base of the opening but do not pass the ETT/ stylet through.
At that point, remove the stylet (should be possible with your right thumb) and slightly advance the ETT(with the rest of your right hand). The ETT should slide "up and into"into the opening. The stylet does not enter through the vocal cord opening at all.

I have had excellent results with this technique. Hope this helps.

absolutely. once the tip of ETT is through the cords put your right hand into a "thumbs down" position, use index finger to wrap around the black handle of the stylette and the thumb to push the tube into trachea over stylette.

 

[Sergio99]

Hello,

What a great thread! Everybody gives a useful piece of his own experience. We bought a Glidescope recently, and I had a chance to use it only a few times. Now I will want to try every advice given here. Thank you all, and keep it coming.

Greetings

 

[DrBrown]

My two cents:

1. Place the Ett in the mouth BEFORE you put in the blade (you may use a second person to hold it in the posterior pharynx
2.Use the stylet provided by the Glidescope folks
3.Lube the stylet
4.Get the ett down to the cords then slide it off seldinger style

It really is a great tool. Try the above to improve you chances...good luck

 

[sevoflurane]

My two cents:

1. Place the Ett in the mouth BEFORE you put in the blade

Definately true for truly difficult AW that are anterior and have a small mouth opening. You don't have to manuver the ETT/stylet as much if it's already near the glottic opening. Working space between the teeth and the blade can be very small. Twist the ETT on it's short axis to get the tip to move... small degree of rotation = large movements distaly.

Come in from the side of the mouth -RETROMOLAR- if possible. More wiggle room.

The glidescope stylet is good for most cases... Sometimes you need an exagerated bend on the ETT to fit a particular patient anatomy and that requires regular bendable stylet.

If you still can't get through, consider a 2 man technique: One holds the glidescope, the other uses the FO scope. Position the tip of the FO scope near or in the glottic opening under direct vision on the glidescope screen, then drive the snake home.

Most of the time... people who are new to the device are either not midline with the blade or are in too far.

 

[sweetalkr]

We use the glidescope a lot.

great points brought up. I do the following:
ensure you are using the glidescope blade and ETT
1) Ask someone to pull the side of the mouth
2) different bend on the tube
3) you can place the tube in the mouth beforehand
4) ventilate, then try as best you can to place the glidescope further to the left. difficult but possible
5) bougie or smaller ETT.