Translaryngeal Guided Intubation


Translaryngeal Guided Intubation, Retrograde Intubation

  • Indications
  1. Difficult Endotracheal Intubation despite ability to oxygenate and ventilate a patient in need of Advanced Airway
    1. Procedure allows for continued ventilation and oxygenation during procedure
  • Preparation
  1. Retrograde Intubation kits (e.g. Cook) are available
    1. Central Line kit may be used instead
    2. Airway exchange catheter kit may also be used
  2. Introducer needle (that allows passage of the seldinger wire)
  3. Syringe
  4. Seldinger Guidewire
    1. Stiffer guidewires are preferred (e.g. 145 cm angiowire) if available
  5. Hemostat
  • Technique
  1. Continue Bag Valve Mask until Endotracheal Tube insertion
  2. Perform Needle Cricothyrotomy
    1. Insert introducer needle through skin and angled toward the oropharynx
    2. Pass introducer needle through skin and cricothyroid membrane and into trachea
    3. Aspirate while inserting needle until aspirating air easily
  3. Insert Seldinger guidewire
    1. Thread the wire up until it is visualized in the oropharynx
    2. Apply hemostat to the end of the guidewire at the neck insertion site (prevents migration)
    3. Allow for slack at the guidewire insertion to allow for greater depth of ET Tube insertion before guidewire removal
  4. Insert Endotracheal Tube
    1. Thread the guidewire through the murphy eye hole at the end of the Endotracheal Tube
    2. Pass the Endotracheal Tube over the guidewire until it has passed through the Vocal Cords
    3. Remove the guidewire
    4. Pass the Endotracheal Tube further to its full insertion point and inflate balloon
  5. Confirm Endotracheal Tube placement
    1. End tidal CO2
    2. Chest and Abdomen auscultation
    3. Chest XRay
  • References
  1. Braude and Weingart (2024) Retrograde Intubation, EM:Rap 24(1)
  2. Guest and Catalano (2023) Retrograde Intubation, EM:Rap 23(11)