Intubation Tips

[sweetdreame, BSN, RN]

Hello! I am a SRNA learning to intubate and have found that my left arm gets tired REALLY easily. I start out well and can see the cords, but I can barely hold the position long enough to get the tube in! Do any of you have any special tips to strengthen the arm, or do you think it is a technique problem?

Maybe I'm just a wimp!?

[wtbcrna, MSN, DNP, CRNA]

This is just a technique problem.

You should start out with the bed in comfortable position for you not your preceptor when you goto intubate. It should only take a minimal amount of force to intubate with grade I/II views that you should only need your thumb and first 2 fingers, if you find yourself needing more force than that then you should pause and reevaluate (use your other fingers to help balance the handle/blade).

Once you have done about 100 DLs/intubations you will find the technique that works best for you. It just takes time and practice.

[sweetdreame, BSN, RN]

Thank you very much for the reply. I sincerely respect your opinion and have followed several of your postings. Have a good day!

[Da_Milk_of_Amnesia, MSN]

SRNA here - I have found that positioning and mouth opening are perhaps 2 of the biggest places where were fail/ make our lives way harder than they need to be. I always raise the table up so that patient is roughly at the level of my xiphoid and if you relax someone enough you should really be able to open that mouth really easily. I don't find myself using a lot of force at all to intubate most patients - If you're getting tired then it sounds like you're not in the right spot, not moving the tongue totally out of the way, you shouldn't need that much force to tube most people unless they are wayyy anterior. Also it never hurts to ask for cricoid pressure, i frequently do and if that make me a mediocre incubator (is that even a word? - Oh well it is now) then whatever, I haven't goosed a tube yet. Also it depends on what blade your using - I find myself using way more force with a mac than I do with a miller. I started learning with a mac and I gave up on it and went to the miller and haven't looked back since - Altho I have to be get better with it at some point. Anyways Hope that helps.

[ckh23, BSN, RN]

I would also add that leaning back may help. Sometimes we get so focused on the view that we are so close to the mouth it limits our view. Sometimes leaning back will give you a greater viewing areas to see.

[missnurse01, MSN, RN]

I also felt that I needed more force with a mac and left it and went to the miller and started being successful. In the last few months I have gone back to the mac so I could learn that one as well and no longer feel like it takes as much force. I agree about the positioning of the pt and also I no longer crank the head way back. I think that was hindering me. I ask for cricoid if I can see only the very bottom of the cords or will sometimes reach around to wiggle it a little myself to get it to drop down and open up. I think all the time what I could tell new students to make it easier to them, other than what they already tell us about positioning, cricoid, elbow tucked in, etc... It is such a learning experience thing it's hard to give sound advice. good luck!