Placement of a cuffed tube through the vocal cords into the trachea for controlled ventilation and airway protection.
Indications
- • Respiratory failure
- • Airway protection (GCS ≤ 8)
- • Cardiac arrest
- • Anticipated deterioration
- • General anesthesia
Contraindications
- ⚠ No absolute; caution in unstable C-spine, difficult airway
Equipment
- • Laryngoscope + blades (Mac 3–4)
- • ETT 7.0–8.0 (F) 7.5–8.5 (M) + stylet
- • 10 mL syringe
- • Bougie
- • Suction (Yankauer)
- • ETCO2 detector
- • BVM + O2
- • Rescue: LMA, cricothyrotomy kit
- • Drugs: induction + paralytic
Positioning
- • Sniffing position; ear-to-sternal notch alignment; ramp obese patients.
Consent
- • Explain indication, benefits, alternatives
- • Explain risks & complications
- • Obtain written/verbal consent as per SOP
- • Document consent
Universal precautions
- • Hand hygiene
- • PPE — gloves, mask, eye protection
- • Aseptic technique
- • Sharps safety
- • Verify patient identity & site
Step-by-step (0/7)
Tap to complete
100% O2 × 3 min or 8 vital-capacity breaths.
Pearl: Apneic O2 via NC 15 L/min extends safe time
Immediate complications
- ⚠ Esophageal intubation
- ⚠ Right mainstem
- ⚠ Hypoxia
- ⚠ Dental trauma
- ⚠ Vocal cord injury
- ⚠ Aspiration
- ⚠ Hemodynamic collapse
Delayed complications
- • Sore throat
- • Subglottic stenosis
- • VAP
Recognition
- • No ETCO2
- • Unilateral breath sounds
- • Falling SpO2
Initial management
- • Withdraw & re-attempt
- • Reposition if mainstem
- • Call for help early
Prevention
- • Pre-oxygenate
- • ETCO2 confirmation
- • Bougie use
- • Check depth
Post-procedure observation
- • Continuous SpO2, ETCO2
- • Sedation/analgesia titration
Monitoring
- • Cuff pressure q4h
- • ETT position on CXR
Documentation
- • Grade of view (Cormack-Lehane)
- • Attempts
- • Drugs used
- • Depth
Patient instructions
- • Confirm placement on transfer
Educational bedside guide. Perform only under supervision until competent. Follow local SOPs and consent policy.
