VL can be deceptively reassuring. The crystal-clear views might make you think this is going to be easier than you expected — but don’t be fooled. Sure, the learning curve for basic proficiency is often shorter than with direct laryngoscopy. But if you want to take your VL technique from good to great, you’ll need to master a few key VL-specific skills and concepts. That’s because while the tech can help you coast for a while, the day will come when it doesn’t — when the view isn’t perfect, the airway is messy, or the delivery just isn’t working. In that moment, real mastery is what makes the difference. So let’s shift our focus to the specific mechanics and mindset of VL — the things that will define your success. By the end of this section, you’ll not only understand what makes VL powerful, but also exactly where you need to level up to use it at its full potential.

Here are the key skills:

Gaze Shifting

Gaze Shifting

A crucial yet often overlooked skill is the ability to shift your gaze between the patient and the screen. Beginners may struggle with this transition, getting focus locked on the screen or the patient, or misjudging the timing. Such difficulties can hinder your intubation attempt and inadvertently cause injury to your patient. Take a moment to review this video for guidance, then practice to enhance your gaze-shifting skills.

Protecting Your Optics

Protecting Your Optics

The benefit of VL, which provides a clear view on a high-quality screen, depends on the camera on the blade. Blood, mucus, vomit, glare, fogging, and other technical issues can compromise that view and make intubation difficult. Remembering to protect your optics will enhance any VL technique you develop.

Lead with suction

Prevent contamination of your laryngoscope’s optics by looking in the mouth and utilizing a suction device, such as a large-bore DuCanto Catheter or Yankauer. Blindly inserting your laryngoscope blade may rapidly lead to a diminished view as secretions and other airway contaminants obscure your camera.

Stay high & Dry

Avoid secretions and airway contaminants by hugging the base of the tongue to stay “high and dry” as you advance the tip of the blade towards the epiglottis and into the vallecula. Most airway fluids will pool in the posterior oropharynx. You can avoid them by hugging the base of the tongue as you insert and advance the blade.

View Optimization for VL

The VL View

VL can give you a stunning view of the glottic opening — but don’t mistake “best” for “optimal.” That full-frame, crystal-clear image might look impressive, but it could actually make tube delivery harder. One of the most important skills in VL is knowing how to adjust your view for success. That means finding the right distance between the camera and the cords to give you room to maneuver, and aligning the blade’s angle with the natural downward slope of the trachea. Without that alignment, you’ll be fighting the anatomy — jamming the tube in from a steep, awkward angle. Smart VL isn’t just about seeing clearly — it’s about setting yourself up for a smooth, successful intubation.

Don’t Get Too Close

Getting up close will give you a great view of the anatomy, but if the blade is too close, the glottic structures will take up most of the screen, reducing the working space in the field of view. As the tube is inserted, it will also take up most of the screen and block your view of the trachea. A too-close perspective can also make it harder to judge distances, hindering alignment of the endotracheal tube (ETT) with the vocal cords.

Too Acute (Angle of Approach)

The endotracheal tube (ETT) can enter at a steep angle, complicating its passage through the vocal cords and potentially causing it to strike the anterior commissure. As a result, the tube may repeatedly contact anterior structures rather than advancing smoothly into the trachea. If the tube becomes misaligned, redirecting it can be challenging due to limited maneuvering space.

If you closely examine the images above, you will notice that the tracheal rings are visible in the “too close” image. This indicates that the view is too acute as well! The ideal view is where the trachea appears “dark and deep.” This signifies that the angle to the trachea is optimal for tube delivery.

Tube Delivery & Tracheal Access

Tube Delivery Skills

The Universal Concepts of Progressive Laryngoscopy Still Apply

Video laryngoscopy comes with its own technology and device-specific techniques, but at the end of the day, it’s not an entirely different procedure. If you’re already experienced with DL, much of your approach should stay grounded in the same best practices of progressive laryngoscopy: a stepwise method that builds the view, minimizes trauma, and sets you up for first-pass success. It’s all about taking the time to optimize your view before delivering the tube. If you’re new to laryngoscopy (or just want a quick refresher on progressive laryngoscopy), review these laryngoscopy essentials here before diving into the VL-specific skills below.

This guide is part of our digitally enhanced, hands-on curriculum designed to help you master video laryngoscopy. Step up to the practice station, place your mobile device in the holder, and use voice commands to navigate through the training. A step-by-step practice guide is below as an additional resource.

• Step up to the hands-on station.
• Place your mobile device in the holder.
• Start the video.
• Use hands-free commands.
• Pause and practice key skills.

It’s time to focus on establishing the key skills you need for success. Review, practice, repeat, and then head to the next station when you’re ready.

Valuable Troubleshooting Skills

When tube delivery gets tough, having a few reliable tricks up your sleeve can make all the difference. These high-yield techniques are designed to get you out of tight spots and back on track quickly. Take time to learn them well — and more importantly, practice them. Head to our hands-on, self-guided station to get the reps you need to make these maneuvers second nature.

Avoiding Glare

VL screens may give you a great view — but only if you protect it. The clarity of the image depends on how well the camera adjusts to ambient light, a process that’s mostly automatic in modern devices but far from foolproof. Foamy secretions, blood, or even tongue discoloration can throw off the color balance, create glare, and obscure critical details. A little prep goes a long way: suction aggressively to clear the field, and know how to manually calibrate your device’s white balance when the automatic setting falls short.

Avoid Inserting too Deep