tips for glidescope intubations

[scottpilgrim]

hello

i know this might be a silly question, but would anyone like to share any tips to optimize glidescope intubations?
at this point, i am usually successful, but it requires a lot of tinkering was hoping for some insight.

some of my more common problems is seeing a grade 2-3 view of the cords but being unable to curve the tube up appropriately.

thank you

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[deleted162650]

Try playing around with different size blades on the glidescope. We now have 3 different generations of Glidescopes at my shop and I've found that each one tends to provide the best view with different size blades. Use the rigid glidescope stylet. Hold it way back at the end for maximum maneuverability. Once you can see the tube tip on the screen, try dropping your right hand down so the tube is almost horizontal with the floor, now by twisting the stylet you can get the tip of the tube even more anterior.

 

[Stank811]

Make sure the tip of the glidescope is in the vallecula. The tip of the glidescope often catches the epiglottis which will then lift the whole larynx making it hard to place the tube even with the glidescope stylet.

 

[Planktonmd]

Do not attempt to get a perfect view of the cods because if you do you probably will be too close to the glottis to allow the tube to pass.
a view of half the cords is all you need and always use the provided rigid stylet.
Without the rigid Stylet the Glidescope is worthless.

 

[goosegas]

As the others have said, always use the rigid stylet. And don't hold the styleted tube in the middle like you would if performing DL. Hold the stylet at the very top and work it like a slot machine. Don't insert the tube too far before you start your slot machine maneuver. You want to just see the tip of the tube in the right lower corner of the screen and then start the slot machine motion.

 

[caligas]

Use a size smaller ett and lube it.

 

[Planktonmd]

Use a size smaller ett and lube it.

Why do you think that a size smaller ETT is better???
You are not alone... there are many CRNA's out there who share your beliefs but I really would love to know how a smaller ETT is helpful????

 

[IlDestriero]

You definitely don't need a size lower. The biggest mistake I see over and over is that the glidescope is too close to the trachea. Move back a bit and you will have a lot more room to work. Other than that, as salty dog mentioned, rotating the tube laterally to the right and then turning it counter clockwise can put the tip more anterior to advance between the cords.
Use the glide on every patient for a week or two. You will see improvement in your technique.

 

[GasEmDee]

1. Dont place the tip at the valecula if you can get a view of the glottis from further out. If you are too close to the glottis, sometimes the angle is too sharp to pass the tube.

2. Use the glidescope-specific stylette.

3. Sometimes cricoid pressure helps with changing the angle to make it favorable for passing the tube.

 

[caligas]

Why do you think that a size smaller ETT is better???
You are not alone... there are many CRNA's out there who share your beliefs but I really would love to know how a smaller ETT is helpful????

Not usually necessary, but on patients that are very tight in terms of oral aperture I have seen users be able to get a view but be unable to pass the ett even back into the pharynx. A smaller lubed tube does the trick. Turning the tube to the right before passing than rotating back also helps.

 

[geogil]

One additional tip, as you're putting the tube into the mouth, make sure you're watching the tube, not the screen. There are reports in the literature (and at my insitution) of people ramrodding the tube through the tonsilar pillars. Remember, intubation is not a loss-of-resistance technique.

 

[OB1🤙]

If the proprietary stylette is for whatever reason missing or not available- take a regular stylette, and bend it to match the glidescope curve. Problem solved.

 

[Mman]

My super secret tip is that if you can see the cords but can't get the tube to go between them, use a fiberoptic scope as the stylet. You can just watch on the glidescope monitor and flex the tip of the scope when you need to direct it down the trachea. Works every time. Only potential confounder is that if they are extremely anterior you might need to have somebody grab the tube in their pharnyx with Magill forceps and direct it more anteriorly for you (don't grab the scope with the magills).

 

[BLADEMDA]

hello

i know this might be a silly question, but would anyone like to share any tips to optimize glidescope intubations?
at this point, i am usually successful, but it requires a lot of tinkering was hoping for some insight.

some of my more common problems is seeing a grade 2-3 view of the cords but being unable to curve the tube up appropriately.

thank you

Notice how he manipulates the ETT from the top.

 

[BLADEMDA]

 

[BLADEMDA]

The last video has some errors in it:

1. Best to rotate the tube near the top if you are having difficulty
2. Remove the distal portion of the stylet before placing the ETT through the cords (line up ETT with cords and advance ETT while pulling back stylet)

 

[BLADEMDA]

CHICAGO — For fellows in pulmonary and critical care medicine, training with a video laryngoscope, rather than a direct scope, improves first-pass success and decreases the complications of urgent endotracheal intubation, a new study has found.

"I think everybody should be using the video laryngoscope, at least nonanesthesiologists," said Michael Silverberg, MD, from Beth Israel Medical Center, in New York City.

Although research has shown that video laryngoscopy improves glottic visualization during elective surgery in the operating room, direct laryngoscopy is routinely used to perform uncomplicated endotracheal intubation outside the operating room.

This study was designed to test the effectiveness of video laryngoscopy outside the operating room.

Dr. Silverberg presented the research here at CHEST 2013, where he is a semifinalist for the Young Investigator Award.

The researchers compared video with direct laryngoscopy in a prospective randomized controlled trial conducted at an 856-bed medical center with a closed 16-bed medical intensive care unit.

The 153 study participants "were fairly sick," Dr. Silverberg noted. Patients undergoing elective intubation, those with a known history of difficult intubation, and those who had a limited mouth opening were excluded.

The first-pass success rate for fellows in pulmonary and critical care medicine was significantly better with the video laryngoscope than with the direct laryngoscope. After 2 attempts with the direct laryngoscope, fellows were instructed to switch to the video laryngoscope.

 

[BLADEMDA]

hello

i know this might be a silly question, but would anyone like to share any tips to optimize glidescope intubations?
at this point, i am usually successful, but it requires a lot of tinkering was hoping for some insight.

some of my more common problems is seeing a grade 2-3 view of the cords but being unable to curve the tube up appropriately.

thank you

http://forums.studentdoctor.net/threads/i-hate-video-laryngoscopy.1044663/

Read the ENTIRE thread as there are more links to video clips.