Passing tube during intubation

[EBigguns]

I am wondering if there are some good tips on passing the tube during intubation. I read the tips and pearls section, but everything was geared toward obtaining a view of the cords. I have been getting great "full view" of the cords, but sometimes have difficulty passing the ET tube between them. I am too frequently bouncing off arytenoids and other structures. I also find that my view too frequently gets obstructed by the ET tube such that I do not get adequate visualization of the tube actually passing between them. I am curious about the technique of others. Any tips/advice would be most helpful. Thank you.

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[Laryngospasm]

I am wondering if there are some good tips on passing the tube during intubation. I read the tips and pearls section, but everything was geared toward obtaining a view of the cords. I have been getting great "full view" of the cords, but sometimes have difficulty passing the ET tube between them. I am too frequently bouncing off arytenoids and other structures. I also find that my view too frequently gets obstructed by the ET tube such that I do not get adequate visualization of the tube actually passing between them. I am curious about the technique of others. Any tips/advice would be most helpful. Thank you.

1.) Less coffee
2.) Experience
3.) Bigger mouths
4.) Use the right blade for the right mouth
5.) Dont gouge the trachea with the stylet
6.) Align the axis of evil

 

[toughlife]

I am wondering if there are some good tips on passing the tube during intubation. I read the tips and pearls section, but everything was geared toward obtaining a view of the cords. I have been getting great "full view" of the cords, but sometimes have difficulty passing the ET tube between them. I am too frequently bouncing off arytenoids and other structures. I also find that my view too frequently gets obstructed by the ET tube such that I do not get adequate visualization of the tube actually passing between them. I am curious about the technique of others. Any tips/advice would be most helpful. Thank you.

Once you have the cords in full view, turn the tube 90 degrees clockwise which gets the proximal end of the tube out of your field of view (proximal and distal ends of the tube are in the same plane) and allows you to see the distal portion (cuff). I always try that and so far so good.

 

[Noyac]

Try to sweep the blade more to the left sid eof the mouth after sweeping the tongue out of the way. You will still be mostly midline but this will give you more room to see the cords as you approach with the ETT. If you are using a stylet, try intubating without one (I rarely ever use a stylet). The tube is shaped like it is for a reason. If you need to use the stylet then just get to the opening of the cords and have your assistant pull the stylet out (be sure to lube the stylet well so it slides easily) b/4 passing the tube through the cords. If your hockey stick is too acute, it will be difficult to pass the tube beyond the cords. You'll get it, everyone does

 

[toughlife]

Try to sweep the blade more to the left sid eof the mouth after sweeping the tongue out of the way. You will still be mostly midline but this will give you more room to see the cords as you approach with the ETT. If you are using a stylet, try intubating without one (I rarely ever use a stylet). The tube is shaped like it is for a reason. If you need to use the stylet then just get to the opening of the cords and have your assistant pull the stylet out (be sure to lube the stylet well so it slides easily) b/4 passing the tube through the cords. If your hockey stick is too acute, it will be difficult to pass the tube beyond the cords. You'll get it, everyone does

 

[Noyac]

Truce!

 

[VolatileAgent]

5.) Dont gouge the trachea with the stylet

don't use a stylet. stylets are for amateurs (i.e., EMS personnel and ER docs ).

 

[UTSouthwestern]

Try lubricating the end of your tube.

 

[seattledoc]

1. no stylet.
2. note the bevel on the end of the ett. put the tip of the bevel through the cords and the rest will follow.
3. be the ett

 

[jetproppilot]

3. be the ett

Agreed, but only works if you achieve zen by, at the same time you are one-with-the-ett, making the noise Chevy Chase made on Caddy Shack when putting...

"Be the ball..."

"NENENENENNENNEENENNENNENENENENENENENENE..."

 

[jwk]

don't use a stylet. stylets are for amateurs (i.e., EMS personnel and ER docs ).

Sorry, BS - I use a stylet MAYBE 1% of the time, but when I need it, I need it - like when you CAN'T see the cords.

And if you're seeing cords and then blocking your view with the tube, just put the tube in on the right side of the mouth and keep it there as it's going in. The tube is NOT supposed to go in just under the blade.

Jet, you crack me up as always.

 

[Trisomy13]

you push until you hear a "crunch/pop" noise. look at the field. is the tube protruding from the trachea next to the innominate artery fountain? no? you're in!

 

[ThinkFast007]

recently been having some problems with this, could anyone offer anymore advice?