Instructions for endotracheal intubation with the AIROD®
DO NOT USE THE AIROD® IN CHILDREN.
DO NOT USE WITH AN ENDOTRACHEAL TUBE SMALLER THAN 6.5 mm.
1) Prepare all necessary equipment for standard endotracheal intubation.
2) Remove the AIROD® from its sterile packaging and fully extend the three rods so that the two locks are completely engaged. Test the AIROD® to make sure it does not collapse by applying pressure to both ends and try to collapse the AIROD®. Once the operator has confirmed that the AIROD® is fully extended and locked proceed. DO NOT PROCEED IF THE AIROD® IS NOT FULLY EXTENDED AND LOCKED.3) Lubricate the proximal tip of the AIROD® as well as the tip of the endotracheal tube.
6) Hyper-oxygenate the patient with 100% oxygen for 2 minutes with bag-valve mask ventilation.
7) Open the patient’s mouth and gently insert the laryngoscope into the oropharynx taking care not to damage the teeth or oropharyngeal tissue.
a) If using a Mac blade slide the blade above the epiglottis and into the vallecula.
b) If using a Miller blade slide the blade underneath the epiglottis.
8) Using your left hand lift the laryngoscope upward and forward to expose the vocal cords making sure not to use the teeth as a fulcrum.
9) Next with your right hand grasp the AIROD® like a pencil at the proximal end along the smallest reinforced rod with the 20- degree tip pointing upward.
10) Gently advance the AIROD® past the mouth and down into the hypopharynx approximately 1-2 cm past the vocal cords.
11) Hold the AIROD® in this position while an assistant advances a 6.5 mm or greater endotracheal tube over the distal end of the AIROD® towards the proximal tip of the AIROD®.
12) Using your right hand release the AIROD® and immediately grip the endotracheal tube as it is advanced over the AIROD®.
13) While an assistant holds the distal end of the AIROD® to prevent advancement further into the trachea, gently advance the endotracheal tube the rest of the way down the AIROD® and into the trachea taking care not to damage the vocal cords.
14) Once the endotracheal tube is in the desired position in the trachea have the assistant withdraw the AIROD® while the operator holds the endotracheal tube in position to prevent accidental removal of the endotracheal tube.
15) Inflate the endotracheal balloon.
16) Attach a CO2 detector to the end of the endotracheal tube.
17) Ventilate with a bag-valve mask ensuring CO2 detector color change.
18) Auscultate the chest making sure there is good chest rise and breath sounds heard throughout all four quadrants of the lungs.
19) Confirm appropriate endotracheal tube placement with a chest x-ray.
Complications associated with the misuse of the AIROD® during endotracheal intubation may include:
1) An endotracheal tube that is mistakenly sized or misplaced, especially in an apneic patient, can quickly lead to hypoxia and death.
2) Accidental intubation of the esophagus.
3) Oropharyngeal trauma.
4) Broken teeth.
5) Tracheobronchial perforation.
6) Esophageal perforation.