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.
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
- Confirm indication for intubation and gather equipment for immediate placement verification.
- Test ETT cuff with 10 mL air, then deflate to readiness.
- Lubricate distal tube end and insert stylet.
- Position patient head in neutral alignment.
- Insert laryngoscope with left hand and visualize airway landmarks.
- Advance ETT past vocal cords into the trachea.
- Align depth marker at vocal cords during insertion and confirm adult depth target around 20-25 cm at the mouth corner.
- Remove stylet and inflate cuff with 10 mL air.
- Apply oxygen and check for chest rise.
- Verify tracheal placement with CO2 detector/colorimetric change and bilateral lung sound assessment.
- Obtain chest X-ray confirmation and secure the tube with a stabilization device.
- Document exact insertion depth landmark at lips/teeth and reassess cuff pressure 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.
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.