Make suction
part of the
procedure.
A suitable catheter is the starting point. Learn why its design matters, how it works alongside the blade, and why a field that keeps filling needs continuing drainage.
FOUR ROOMS / ONE INSTRUMENT COMPARISON TABLE
The tool. The technique.
The two hands.
Follow the shift from intermittent cleanup to suction integrated into the procedure.
Protected Airway Collaborative · Kimberly AI narration, with generated ER ambience and suction. Cover: SAL-07, illustrative poster from the PAC Collection.
Read the transcript
[Emergency room ambience and suction open the film, continue softly beneath the narration, and fade at the end.]
Suction has always been an essential part of the airway setup. But for something we depended on, we gave it remarkably little attention. We checked that it was there. We spent less time asking whether we had the right tool—or whether we needed to practice using it.
In hindsight, that was a serious oversight.
Jim DuCanto challenged both assumptions. He recognized the need for a large-bore rigid suction catheter designed for the demands of a contaminated airway. He also understood that a better tool would accomplish little if we kept using it the same way.
You know the sequence: suction, put the catheter down, try to get a view. Contamination keeps coming up from the esophagus, and the view disappears again. Reach for suction. Start over.
The airway keeps filling while we alternate between clearing it and trying to intubate.
SALAD addresses that coordination problem by integrating suction into laryngoscopy. The catheter has a continuing job as the blade advances and the right hand prepares to deliver the tube. That takes a suitable instrument and a movement worth practicing.
In this gallery, we’ll examine why contamination defeats that familiar sequence, take a closer look at the large-bore suction catheter, and explore how the left and right hands work together to keep the procedure moving.
Let’s get started.
Download English captionsMeet the
large-bore catheter.
DuCanto large-bore suction catheter
The curved, rigid shaft lets the operator direct the tip along the airway while clearing ahead of the blade. Find the curve and tubing connection on the labeled training device.
Source photograph supplied by the PAC owner; photographer, manufacturer credit, and date not stated. Background treatment AI-assisted by PAC, 2026.
View original source photograph ↗
Four catheter openings
Compare the distal openings and side ports. The passage has to accommodate the material being removed; the catheter, tubing, canister, and suction source all affect the working system. A photograph cannot establish its performance.
Source photograph supplied by the PAC owner; photographer, manufacturer credit, and date not stated. Background and highlight treatment AI-assisted by PAC, 2026.
View original comparison photograph ↗Yankauer vs DuCanto: a suction comparison
Compare clearing in this demonstration. The timers describe this setup, fluid, and suction system; they do not establish a universal device ranking or a patient outcome.
Edited by PAC from a demonstration by Jason Bowman. Watch Jason Bowman’s full video on YouTube ↗
Suction and Laryngoscopy.
Building the View Together.
The SALAD definition
The catheter clears ahead of the blade, then remains in use during tube delivery. Exhibit 02 follows that change in position.
Source definition: PAC. Visual adaptation generated with AI, 2026.
View original graphic ↗
Two hands, one purpose
Compare the two-hand graphic with the training photograph.
PAC collection · Original graphic ↗ · Training photo ↗
Develop and
maintain the view.
The laryngoscope controls the tongue and develops the view. Keep that position while the catheter is moved out of the tube’s path.
Clear, park,
then deliver.
With suction running, keep the catheter tip in view as you clear material. Use the rigid catheter to help displace the tongue and lower jaw, creating space for the laryngoscope. Maintain that space until the advancing blade takes control of the airway structures.
Handling cue: Keep the movement controlled and the tip visible. If visibility is lost or resistance prevents controlled movement, stop advancing and reassess.
Once the catheter is parked to the blade’s left with its tip in the upper esophagus, the right hand can deliver the tube while suction continues to drain the contaminated field.
Static pool
or material still arriving?
A pool can be cleared and the view recovered. With ongoing contamination, the field fills again while the operator reaches for the tube. That is the problem the parked catheter is intended to address.
What has collected?
Blood, vomit, or secretions can hide anatomy and soil a video lens. Clearing the collected material creates a view; it does not tell you whether the source has stopped.
Is more material still arriving?
Watch whether the field refills after clearing. If material continues to arrive from the esophagus, putting the catheter down removes drainage at the moment the right hand is needed for the tube.
Shocking Tales of Massive Airway Contamination
The original comic-inspired film follows an encounter with heavy airway contamination. Use it as a case story after working through the instrument and coordination cues.
Cover: SAL-F03-C02 · Shocking Tales of a Horribly Soiled Airway. Original cover art: Andi Cannon. Story: James DuCanto and Chris Root. Monochrome NYC adaptation generated with AI, 2026. View original poster ↗
Source: legacy PAC SALAD page. The page credits Jim DuCanto and friends; complete production credits remain to be verified.
Open original film ↗If playback is unavailable, use the written teaching alongside it.
What improves with the device and in the simulator
After SALAD training, learners felt more confident and rated their suction skills higher; paramedics trained in SALAD also intubated a contaminated manikin on the first try more often. In a randomized simulation study, hyperangulated video laryngoscopy achieved higher first-pass success and shorter times to intubation and ventilation than direct laryngoscopy. Both groups used SALAD; patient outcomes were not measured.
PAC identifies DuCanto as an anesthesiologist and educator and credits him with the SALAD technique, simulator, and DuCanto catheter. The original PACscape credits Jonathan St George, with contributions from Chris Root and Jess Boyle.
Evidence & source notes →
The procedural reference. Root et al. describe how suction is integrated with laryngoscopy and maintained through tube delivery. This is the clinical anchor for the Gallery and Studio sequence.
Root et al. · SALAD technique and evidence review (2020) ↗What training studies measured. In the original 40-learner simulator report, confidence and self-perceived skill increased after training. Those self-reports did not measure clinical competence or patient outcomes.
DuCanto et al. · The SALAD simulator (2017) ↗In SATIATED, 164 paramedics were randomized to different training schedules. First-attempt success on the second manikin attempt was higher in the group already trained in SALAD. The fixed, tabletop manikin and simulated fluid limit how directly that result transfers to an emergency airway.
Pilbery & Teare · SATIATED randomized manikin study (2019) ↗Results are not uniform. Fiore et al. compared three approaches in 31 residents. They found no statistically significant difference in lower-airway fluid volume or time to intubation. The study was underpowered; this does not establish that the techniques are equivalent.
Fiore et al. · Three approaches to simulated massive emesis (2019) ↗Device choice within SALAD. A 2026 randomized simulation study of 200 physicians reported higher first-pass success with hyperangulated video laryngoscopy than direct laryngoscopy. Both groups used a SALAD workflow. This compares laryngoscopes in that model, not SALAD against no SALAD. It did not measure patient outcomes.
Uzun et al. · Direct versus video laryngoscopy during SALAD (2026; abstract reviewed) ↗Read the sequence with its limits. This teaching sequence follows the upper-esophagus position in Root’s procedural text. The figure caption instead describes the tip seated in the hypopharynx. Both describe continuing drainage with the catheter to the blade’s left. No insertion depth is specified. Rehearse controlled placement with the clinical educator.
After tube clearance. Ventilation and confirmation belong together: assess sustained exhaled carbon dioxide using waveform capnography, alongside oxygenation and ventilation. If sustained exhaled carbon dioxide is absent, urgently exclude esophageal intubation and follow the airway rescue plan.
Chrimes et al. · PUMA guideline on preventing unrecognised oesophageal intubation (2022) ↗Root et al. also raise a potential disadvantage: continuous suction may remove oxygenated gas from the oropharynx. They did not measure that physiological effect in this paper. A usable view does not establish adequate oxygenation, and simulation success does not establish reduced aspiration, complications, or mortality in patients.
Carry forward A self-rating, a manikin result, and a patient outcome answer different questions. Check what each study actually measured.
SAL-A19 · AI-generated brick and iron etching ↗Put the two tools
side by side.
At the comparison table, find the training Yankauer and large-bore suction catheter with their labels and instructions. Begin by identifying both objects.
Enter the Practice Studio ↗SAL-A04 v2 · AI-generated etched tunnel scene ↗