a. Miller blade size 1 for full-term infant

b. Miller blade size 0 for preterm infant (size 00 for

extremely low birth weight infant)

Straight rather than curved blades are preferred

for optimal visualization.

c. Modified blade to allow continuous flow of oxygen

at 1 to 2 L/min for better maintenance of oxygenation during procedure. The use of a Viewmax

(Rusch, Duluth, Georgia) laryngoscope improves

viewing of the larynx but requires a longer time for

tracheal intubation (6).

6. Scissors

7. Oxygen tubing

8. Magill forceps (optional)

Nonsterile

9. Humidified oxygen/air source, blender, and analyzer

10. Resuscitation bag and mask

11. Suctioning device

12. Cardiorespiratory monitor

13. Pulse oximetry oxygen saturation monitor

14. Stethoscope

15. Adhesive tape: Two 8- to 10-cm lengths of 0.5-inch-wide

tape, with half the length split and one 10- to 15-cm

length unsplit

Chapter 36 ■ Endotracheal Intubation 237

D. Precautions (Table 36.2)

1. Select orotracheal route for all emergency intubations

or when a bleeding diathesis is present. Reserve nasotracheal intubation for elective procedures after stabilization with orotracheal tube, unless oral anatomy precludes oral intubation.

2. Prepare all equipment before starting procedure. Keep

equipment ready at bedside of patients likely to require

intubation.

3. Use appropriate-size tubes (Table 36.1). To minimize

upper airway trauma, the tube should not fit tightly

between the vocal cords.

4. To minimize hypoxia, each intubation attempt should

be limited to 20 seconds. Interrupt an unsuccessful

attempt to stabilize the infant with bag-and-mask ventilation. In most cases, an infant can be adequately ventilated by bag and mask, so endotracheal intubation can

be achieved as a controlled procedure. The one important exception is in a case of prenatally diagnosed or

suspected congenital diaphragmatic hernia.

5. Recognize anatomic features of neonatal upper airway

(Fig. 36.2).

6. Ensure visualization of larynx. This is the most important step (Fig. 36.3).

a. Have an assistant maintain proper position of

patient.

b. Avoid hyperextending or rotating neck.

7. Do not use pressure or force that may predispose to

trauma.

a. Avoid using maxilla as fulcrum for laryngoscope

blade.

b. Avoid excessive external tracheal pressure.

c. Avoid pushing tube against any obstruction.

8. Make certain all attachments are secure.

a. Avoid obscuring the point of connection of tube and

adapter with any fixation device.

C