To suction/intubate a patient with significant blood, emesis, or secretions within the airway

CONTRAINDICATIONS

 Contraindications to direct laryngoscopy

SUPPLIES

 All necessary supplies for intubation (see Chapter 1)

 Endotracheal tube (ETT) (without stylet, or can use stylet if you have a swivel adapter with a perforated head)

 Neonatal meconium aspirator

 Suction

TECHNIQUE

 Aspiration without Stylet

    Connect meconium aspirator to the end of ETT—see FIGURE 5.1

    Connect suction to meconium aspirator

    Prepare for intubation (preoxygenate, assess airway, position, prepare medications, etc.)

    Occluding suction hole of the meconium aspirator with fingertip will allow ETT to function as a large-bore suction device

 Alternative: Aspiration with Stylet

    Connect common swivel adapter with a perforated rubber head (Bodai Swivel, Sontek Medical, Hingham, MA) to the end of the ETT—see FIGURE 5.2

    Connect meconium aspirator to swivel adapter and connect suction to meconium aspirator

    ETT stylet can be inserted through swivel adapter. See FIGURE 5.3 for complete setup (Figures 5.1–5.3).

COMPLICATIONS

 Inability to visualize cords

 Inability to intubate without stylet (consider using swivel adapter to allow use of stylet in ETT)

 Clogging of ETT

 Contamination of ETT

 Inability to suction

 Inability to intubate

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