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Intubation - routine

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Assistance

Assistance from trained nursing staff or an anaesthetic technician is mandatory for all intubations. Senior PICU staff should always be informed about an intubation.

Equipment

Equipment is contained within the intubation trolley. A Yankeur sucker must always be present. The laryngoscope must be checked before starting. A second laryngoscope must always be present

Drugs

Intubation is usually achieved using a sedative/hypnotic + muscle relaxant technique (see anaesthetic drugs) or inhalational anaesthetic agent

Preventing aspiration

Elective intubation is preferably performed with an empty stomach (see Starship Anaesthesia Starvation Guidelines). Consideration of cricoid pressure should be given to emergent intubation

Laryngoscopy

  1. Ensure the head is correctly positioned and supported
    1. < 6 years - no pillow
    2. > 6 years - flex cervical spine with pillow to improve view
    3. beware of unstable cervical spine
  2. Examine teeth
  3. Straight blade often preferable in neonates and small infants
  4. Pre-oxygenate
  5. Listen with stethoscope in axillae after intubation to r/o endobronchial intubation
  6. Confirm correct placement by capnography & CXR
  7. An attempt at intubation should be abandoned after 30 seconds (or desaturation <90%) and the patient re-oxygenated with a bag-mask before a second attempt is made.
  8. It is usual to secure an oral intubation before establishing nasal intubation. Strapping of nasotracheal tubes is described in nursing protocols.

Prediction tube size chart and formulae

Age Weight (kg) Int Dia At Lip At Nose Sucker
Newborn <0.7 2.0 5.0 6 6
Newborn <1 2.5 5.5 7 6
Newborn 1 3.0 6.0 7.5 7
Newborn 2 3.0 7.0 9 7
Newborn 3 3.0 8.5 10.5 7
Newborn 3.5 3.5 9.0 11 8
3 months 6 3.5 10 12 8
1 year 10 4.0 11 14 8
2 year 12 4.5 12 15 8
3 year 14 4.5 13 16 10
4 year 16 5.0 14 17 10
6 year 20 5.5 15 19 10
8 year 24 6.0 16 20 12
10 year 30 6.5 17 21 12
12 year 38 7.0 18 22 12
14 year 50 7.5 19 23 12
Adult 60 8.0 20 24 12

ETT size mm = 4 + age/4
ETT length (cm) at lip = 12 + age/2
ETT length (cm) at nose = 15 + age/2

You can download a one page pdf printable version of the prediction tube size chart and formulae here.

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Document Control

  • Date last published: 31 October 2005
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Author(s): Brian Anderson
  • Editor: John Beca
  • Review frequency: 2 years