Guide to Best Practices for Endotracheal Intubation

In critical medical situations where every second counts, endotracheal intubation stands as a vital procedure for cardiopulmonary resuscitation, anesthesia administration, and respiratory management. This comprehensive guide outlines the essential preparation steps to ensure medical professionals are fully equipped to perform this life-saving technique.

Endotracheal intubation involves inserting a flexible plastic tube through the mouth or nose into the trachea to establish an effective airway. This procedure serves as a crucial intervention during cardiac arrest, surgical anesthesia, and prolonged respiratory support. Proficiency in intubation preparation remains a fundamental requirement for all healthcare providers.

Successful intubation requires meticulous preparation. The following checklist ensures comprehensive readiness:

• Protective equipment: Gloves, masks, and eye protection form the primary defense against infection risks. Proper donning before patient contact is mandatory.

• Tube selection: Choose appropriate sizes based on patient age, height, and weight. Standard sizes range from 7.0-8.5mm for adults, with smaller sizes for pediatric patients.
• Inspection: Verify package integrity and check for any tube defects before use.

• Stylet insertion: Provides optimal tube curvature for easier passage through vocal cords. Ensure the stylet tip doesn't protrude beyond the tube end to prevent mucosal injury.

• Blade attachment: Confirm secure connection between blade and handle.
• Light verification: Test illumination brightness and battery capacity before procedure.

• Cuff testing: Inflate with syringe to check for leaks and proper inflation capacity.
• Pressure monitoring: Maintain cuff pressure between 20-30cm H2O to prevent complications.

• Adhesive tape: Use breathable medical tape in H or U-shaped configurations for secure fixation.
• Bite block: Prevents tube compression from patient biting while protecting oral mucosa.

• Pre-oxygenation: Verify bag integrity and mask fit for effective ventilation prior to intubation.

Confirm proper blade-handle connection and adequate lighting for optimal visualization.

Inspect the endotracheal tube for defects and test cuff inflation using sterile technique.

Insert the stylet to achieve appropriate tube curvature while preventing protrusion beyond the distal end.

Level the bed surface and adjust height to the operator's comfort for ergonomic advantage.

Place a pillow under the patient's head to align pharyngeal and tracheal axes, facilitating vocal cord visualization.

• Airway opening: Pillow under shoulders to relieve tongue obstruction
• Intubation positioning: Pillow under head for optimal anatomical alignment

Regular practice with mannequins under expert supervision enhances technical proficiency and prepares for clinical scenarios.

Effective teamwork between physicians, nurses, and anesthesiologists ensures rapid, coordinated response during critical situations.

Ongoing education through medical literature, training workshops, and clinical experience maintains competency in evolving intubation techniques.