Endotracheal Intubation Procedure

Key Points

• Intubation is performed to secure the airway for obstruction relief, airway protection, ventilation support, or tracheal suctioning.
• Tube preparation, depth control, and immediate placement verification are mandatory safety steps.
• Post-insertion documentation and reassessment reduce delayed recognition of tube migration.
• Maintain ETT cuff pressure in a safe range (about 20-30 cm H2O) to reduce tracheal injury and leak risk.

Equipment

• Endotracheal tube (ETT) in appropriate size
• Stylet and water-soluble lubricant
• Laryngoscope with suitable blade and functioning light
• Syringe with 10 mL air for cuff testing/inflation
• CO2 detector or colorimetric device, oxygen source, and securement device

Procedure Steps

1. Confirm indication for intubation and gather equipment for immediate placement verification.
2. Test ETT cuff with 10 mL air, then deflate to readiness.
3. Lubricate distal tube end and insert stylet.
4. Position patient head in neutral alignment.
5. Select laryngoscope blade type/size appropriate for patient anatomy and age (for example adult Macintosh #3/#4; pediatric blade selection per protocol).
6. Insert laryngoscope with left hand, sweep tongue to the left, and visualize epiglottis/vallecula while avoiding leverage on teeth or gums.
7. Advance ETT past vocal cords into the trachea.
8. Align depth marker at vocal cords during insertion and confirm adult depth target around 20-25 cm at the mouth corner.
9. Remove stylet and inflate cuff with 10 mL air.
10. Apply oxygen and check for chest rise.
11. Verify tracheal placement with CO2 detector/colorimetric change and bilateral lung sound assessment.
12. Obtain chest X-ray confirmation and secure the tube with a stabilization device.
13. Document exact insertion depth landmark at lips/teeth, ensure tube tip remains about 3-7 cm above the carina, and reassess for migration.
14. Measure cuff pressure and maintain roughly 20-30 cm H2O (for example by minimal-leak/minimal-occlusion method per protocol).

Common Errors

• Inadequate placement verification → delayed recognition of esophageal or malpositioned tube.
• Incorrect depth management → endobronchial placement or accidental extubation risk.
• Failure to document insertion marking → tube migration may be missed.
• Excessive cuff inflation pressure → tracheal mucosal injury risk.
• Stylet extending beyond ETT tip → tracheal trauma risk.

Related

• advanced-airways-and-intubation - Conceptual framework for indications and airway escalation.
• bag-valve-mask-manual-ventilation - Essential pre-intubation and post-intubation support bridge.