STEPS OF INTUBATION

STEP 1
Holding Laryngoscope
4. Fan out your middle, ring and the little fingers as much as
possible.
1. Learn to hold the laryngoscope using your thumb and the index
finger of the left / right hand.
2. Learn to hold the laryngoscope using your thumb and the index
finger of the left / right hand.
3. Practice to balance the laryngoscope body on the edge of your
hand.

Correct way to hold laryngoscope Wrong way to hold

STEP 2:
Positioning the Baby Head
1. Baby is laid supine with the head partially extended and the neck
slightly flexed
2. Hold the head of baby using the index finger and tumb of your right /
left hand.
3. Be firm and do not let the head move about.

4. Do not hyper extend the neck.

 Holding babies head firmly Learn to extend your ittle finger

STEP 3:
Viewing the Cords
1. The blade of the laryngoscope is inserted gently at the left angle of the
infants mouth.
2. At this stage DO NOT try to visualize the cord now
3. Once you have inserted the blade into the mouth take one step back
and position your head to the edge of the resuscitation table
4. Apply pressure on the cricoid using your little finger (if you have not
practised, ask your assistants to help you).
5. As the blade moves out, its tip slides into the glosso-epiglottic fold and
pulls the epiglottis forwards and the vocal cord come into view.

Do not attempt to visualize cords from

above.

Make sure you Bum sticks out

STEP 4:

1. Looking straight at the head of the infant start moving the body of the
laryngoscope towards you.
2. As the opened mouth moves down towards your visual field you begin
to see the throat.
3. Use suction catheters to clear the airway will help you view of the
epiglottis clearly.
4. Now slowly start withdrawing the blade of the laryngoscope (note you
must push the tip of the blade gently upwards as you withdraw).

Inserting Endotracheal Tube

1. Clear the air way holding the head
firmly in position
2. Make sure you have clear view of the
cord.
3. Seek your assistant’s help to hold the
head of the baby in position.
4. Now quickly pick up the endotracheal
tube using your free hand.
5. Holding the proximal end of the
endotracheal tube, is then gently
passed under direct vision into the
mouth (close to the opposite angle)

6. Insert the tip of the endotracheal tube

through the larynx and then through
the upper trachea.

Why Do We Fail To Intubate ?

Problem Solution
Larngoscope blade too far in
Slowly withdraw the blade
the pharynx

Place baby supine but make sure the neck is slightly flexed,
Neck is hyper extended
.and head is partially extended

Baby’s tongue in your visual Pass the blade over the infants tongue (right to left side or
field .left to right) and firmly depress the tongue
 Endotracheal Tube Fixationfixation
In Pediatric intensive and neonatal care the problem is spontaneous extubation
(tube falling out). This happens because babies and children cannot understand
the importance of endotracheal tube. They are active and will physically remove
the tube when it becomes uncomfortable. Due to this danger the tube are firmly
fixed using retainers. At times the babies hand used to be tied using gauze.

Mouth sealed off Excess salivation

Firm fixation results in distorted face, trauma to the angle of mouth. Babies unable to
open their mouth and move the tongue around will be not helpful in future
development. Psychologists explain that babies communicate using smell and mouth.
Imagine the frustration of these babies
Babies try hard to move the endotracheal tube towards the angle of their mouth. Tube
staying on the angle is probably comfortable, as they can move their tongue and also
reduce palatal grove.

DIY tube holder Distorted face

Intufix:
Endotracheal tube holder stabilizing the tube in the angle of the mouth is comfortable.
This should reduce the incidence of palatal grove and delay in developing speech. The
mouth can be opened and tongue moved about will help salivary secretion to drip out
comfortably.
Babies can also suck dummy and feel contented (helps future psychological
development (
 Tube at the angle of mouth Tube holder on upper lip

The tube holder should be versatile, able to change the location of placing it on the
face. This is because babies may need surgical procedure performed - like dental or
gum surgery, nasal, upper lip surgery (cleft lips).

Tube holder placed on chin Tube pulled out to with holder to demonstrate
stability

Some nurses and doctors find it uncomfortable if the tube holder move. Using
hydrogel tapes to prevent holder moving could help to relieve anxiety (as time pass by
you may start trusting the holder to do the job(.
While changing endotracheal tube - please leave the holder attached to the bonnet of
the baby - you can use the holder to fix the new tube.

Hydrogel tape to stabilize Heatsheild tape to help stabilise

Methods of Endotracheal Tube fixation: