Hospitals & Services

Intubation Flight Check

Personnel (4 people)

  1. Intubator
  2. Cricoid pressure person
  3. Drug/Equipment person
  4. Spare person

 
               Ideally 2 x MO
               ICU Consultant

Drugs

  1. Large IV access (x 2 people if possible)
  2. 1000ml N>Saline running
  3. Induction agent
  4. Neuromuscular blocker (NMB)
  5. Maintenance sedation
    (MnM/Propofol etc)
  6. Long acting NMB
    (if not given in "2")
  7. Vasoactive agents
    (adrenaline/ephedrine etc)

Equipment

 

  1. Bag valve mask
  2. O2 attached and on at 15 L/min
  3. Working suction
  4. Bougli/stylet
  5. Guedel airway
  6. Working  Laryngoscope x 2
    (Mac 3 + 4 blades)
  7. Checked ETT plus lubricant
    (plus smaller size ETT)
  8. 10 ml syringe
  9. Tube tie
  10. NG tube
  11. End Tidal CO2
  12. Monitor Saturation volume 20-30%

NIB 3-5min cycle

Final Preparation

  1. Airway assessed, position optimised and well preoxygenated
  2. Plan B discussed with personnel and equipment available
  3. Communication all personnel know roles and responsibilities

Documentation

  1. Time and date
  2. Drugs
  3. Intubation
  4. ETT position in CXR

ETT cuff pressure

 

Extubation Guideline

 
Ensure adequate assistance, monitoring and equipment as for intubation.

Extubation should generally not be performed when the responsibility to re-intubate might fall on a less experienced staff member.  Patients may be extubated if this action is part of an established care plan or algorithm (eg; cardiothoracic).

No patient should be extubated without medical staff being present and available to assist.

 

 

Patient Selection

 
The patient should be awake enough to maintain their own airway.

Any threat to airway patency as a result of surgery or injury requires consultation with the co-managing team (ENT or Plastic surgery) prior to extubation.

Patient should demonstrate adequate pulmonary reserve.  There are a number of ways of assessing pulmonary reserve although none is perfect:

  • Resp rate <30

  • FVC > 15 ml/kg

  • PaO2 / FiO2 ratio > 200

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Related Documents

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Page last reviewed: 13 May 2014
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