Online + Hands-On Training Resources
The Essentials
Learning Objectives
It’s time to roll! When secretions, vomitus, or blood threaten to swamp your view, SALAD brings suction and laryngoscopy together in beautiful harmony, turning chaos into control. Use this space to dive deep into the SALAD technique — master the tools, train your hands, and keep your airway decontamination skills razor-sharp when it matters most.
- Review & Perform SALAD Technique: During simulated contamination conditions.
- Distract the jaw and insert a large-bore suction catheter.
- Perform continuous suctioning during laryngoscopy to maintain a clear visual field.
- Execute endotracheal intubation while managing ongoing airway contamination
- Build confidence and muscle memory through repeated, structured hands-on practice.
👉 Scroll down to get started. Review the content, absorb the key steps, and then step up to the SALAD simulator. Your journey to mastering the contaminated airway begins now.
🔑 The Keys to Success
The SALAD technique transforms airway management by combining a large-bore rigid suction catheter (RSC) with video laryngoscopy to clear the airway of fluids, blood, or debris. But its true genius lies in the training — learning to skillfully manipulate the laryngoscope in one hand while maneuvering the suction catheter with the other. It’s this synergy of simultaneous actions that makes SALAD so effective. Mastery requires training your hands to work together: using an overhand grip for optimal control, repositioning the suction catheter by “parking” it to the left of the blade in the hypopharynx to create space, and maintaining continuous suction while freeing your right hand to deliver the tube. Keeping suction active throughout the procedure improves visualization and sharpens your ability to navigate even the most challenging airways safely and effectively.
This takes practice — and we’re here to give it to you. Review the videos below and get ready to build your SALAD mastery.
Rapid Review
Need a quick refresher? This Rapid Review video breaks down the SALAD technique’s key steps and concepts in under a minute. Perfect for just-in-time learning, a primer before deeper training, or a quick review right before you manage the airway.
SALAD Procedure
Looking for a deeper dive? This detailed procedure video, courtesy of Bob Barrix and James DuCanto, walks you through the SALAD technique with step-by-step instructions and expert guidance. Learn to perform SALAD quickly, efficiently, and confidently. Take the time to watch this essential resource, then put your knowledge into action with hands-on practice.
Visual Guide to the SALAD Technique
SALAD In Six Steps
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🔧 Step 1: Preparation & Equipment Setup
- Essential Equipment:
- 🟢 Large-bore suction catheter (preferably a DuCanto catheter)
- 🟢 Laryngoscope (video laryngoscopy preferred for visualization)
- 🟢 Endotracheal tube (ETT) + Stylet + 10cc Syringe
- 🟢 Bag-valve-mask (BVM) + O2 Source
- 🟢 Backup airway devices (e.g., supraglottic airway, cricothyrotomy kit)
- Patient Positioning:
- Sniffing position or ramped for obese patients
- BUHE (bed up, head elevated) to reduce passive regurgitation
- ✅ Prepare suction device with continuous wall suction and a clean canister
🧹 Step 2: Initial Airway Decontamination (“Windshield Wiper” Suctioning)
- Hold the suction catheter in an overhand grip (like a microphone)
- Insert the catheter deep into the oropharynx and hypopharynx while maintaining continuous suction
- Perform a side-to-side sweeping motion (windshield wiper technique) to mobilize and clear secretions, vomitus, or blood
- ✅ Prioritize suctioning pooled contaminants before attempting laryngoscopy
💡 Tip: Consider pre-inserting the suction catheter to initiate suction.
👁️ Step 3: Laryngoscopy with Ongoing Suction
- Use the suction catheter to displace the tongue, soft tissue, and open the mouth.
- Insert the laryngoscope blade under direct visualization while maintaining suction
- Continue dynamic suctioning in response to fresh contamination
- Execute the “Park Left” technique:
- Transfer the catheter to the left corner of the mouth, positioning it along the blade to clear secretions from the glottic view
- Ensure the suction tip remains below the tongue base but does not obstruct the blade view
- ✅ Optimize laryngoscope lift and angle to maintain exposure in the presence of contamination
🫁 Step 4: Endotracheal Tube (ETT) Placement
- Once the vocal cords are visualized and major contamination is controlled:
- Pass the ETT through the glottis while maintaining suction
- If secretions pool again, pause advancement to suction and re-establish view
- ✅ Remove the suction catheter only after the ETT cuff is inflated and contamination is controlled
💡 Tip: In anticipated heavy contamination, consider leaving the suction catheter in situ as a pharyngeal drain temporarily
🛡️ Step 5: Post-Intubation Airway Protection
- Suction the ETT lumen and trachea prior to initiating positive pressure ventilation to avoid distal contamination.
- Confirm tube placement and cuff seal.
- Monitor for ongoing contamination; consider placing an oropharyngeal drain if high risk for further soiling
🔍 Additional Insights
✅ Training simulations improve comfort with SALAD; repeated practice is key
✅ Video laryngoscopy improves visualization but requires mastery of dynamic suction.
- Essential Equipment:
- 🟢 Large-bore suction catheter (preferably a DuCanto catheter)
- 🟢 Laryngoscope (video laryngoscopy preferred for visualization)
- 🟢 Endotracheal tube (ETT) + Stylet + 10cc Syringe
- 🟢 Bag-valve-mask (BVM) + O2 Source
- 🟢 Backup airway devices (e.g., supraglottic airway, cricothyrotomy kit)
- Patient Positioning:
- Sniffing position or ramped for obese patients
- BUHE (bed up, head elevated) to reduce passive regurgitation
- ✅ Prepare suction device with continuous wall suction and a clean canister
🧹 Step 2: Initial Airway Decontamination (“Windshield Wiper” Suctioning)
- Hold the suction catheter in an overhand grip (like a microphone)
- Insert the catheter deep into the oropharynx and hypopharynx while maintaining continuous suction
- Perform a side-to-side sweeping motion (windshield wiper technique) to mobilize and clear secretions, vomitus, or blood
- ✅ Prioritize suctioning pooled contaminants before attempting laryngoscopy
💡 Tip: Consider pre-inserting the suction catheter to initiate suction.
👁️ Step 3: Laryngoscopy with Ongoing Suction
- Use the suction catheter to displace the tongue and soft tissue and open the mouth.
- Insert the laryngoscope blade under direct visualization while maintaining suction
- Continue dynamic suctioning in response to fresh contamination
- Execute the “Park Left” technique:
- Transfer the catheter to the left corner of the mouth, positioning it along the blade to clear secretions from the glottic view
- Ensure the suction tip remains below the tongue base but not obstructing the blade view
- ✅ Optimize laryngoscope lift and angle to maintain exposure in the presence of contamination
🫁 Step 4: Endotracheal Tube (ETT) Placement
- Once the vocal cords are visualized and major contamination is controlled:
- Pass the ETT through the glottis while maintaining suction
- If secretions pool again, pause advancement to suction and re-establish view
- ✅ Remove the suction catheter only after the ETT cuff is inflated and contamination is controlled
💡 Tip: In anticipated heavy contamination, consider leaving the suction catheter in situ as a pharyngeal drain temporarily
🛡️ Step 5: Post-Intubation Airway Protection
- Suction the ETT lumen and trachea prior to initiating positive pressure ventilation to avoid distal contamination.
- Confirm tube placement and cuff seal.
- Monitor for ongoing contamination; consider placing an oropharyngeal drain if high risk for further soiling
🔍 Additional Insights
✅ Training simulations improve comfort with SALAD; repeated practice is key
✅ Video laryngoscopy improves visualization but requires mastery of dynamic suction.
🔧 Step 1: Preparation & Equipment Setup
- Essential Equipment:
- 🟢 Large-bore suction catheter (preferably a DuCanto catheter)
- 🟢 Laryngoscope (video laryngoscopy preferred for visualization)
- 🟢 Endotracheal tube (ETT) + Stylet + 10cc Syringe
- 🟢 Bag-valve-mask (BVM) + O2 Source
- 🟢 Backup airway devices (e.g., supraglottic airway, cricothyrotomy kit)
- Patient Positioning:
- Sniffing position or ramped for obese patients
- BUHE (bed up, head elevated) to reduce passive regurgitation
- ✅ Prepare suction device with continuous wall suction and a clean canister
🧹 Step 2: Initial Airway Decontamination (“Windshield Wiper” Suctioning)
- Hold the suction catheter in an overhand grip (like a microphone)
- Insert the catheter deep into the oropharynx and hypopharynx while maintaining continuous suction
- Perform a side-to-side sweeping motion (windshield wiper technique) to mobilize and clear secretions, vomitus, or blood
- ✅ Prioritize suctioning pooled contaminants before attempting laryngoscopy
💡 Tip: Consider pre-inserting the suction catheter to initiate suction.
👁️ Step 3: Laryngoscopy with Ongoing Suction
- Use the suction catheter to displace the tongue, soft tissue, and open the mouth.
- Insert the laryngoscope blade under direct visualization while maintaining suction
- Continue dynamic suctioning in response to fresh contamination
- Execute the “Park Left” technique:
- Transfer the catheter to the left corner of the mouth, positioning it along the blade to clear secretions from the glottic view
- Ensure the suction tip remains below the tongue base but not obstructing the blade view
- ✅ Optimize laryngoscope lift and angle to maintain exposure in the presence of contamination
🫁 Step 4: Endotracheal Tube (ETT) Placement
- Once the vocal cords are visualized and major contamination is controlled:
- Pass the ETT through the glottis while maintaining suction
- If secretions pool again, pause advancement to suction and re-establish view
- ✅ Remove the suction catheter only after the ETT cuff is inflated and contamination is controlled
💡 Tip: In anticipated heavy contamination, consider leaving the suction catheter in situ as a pharyngeal drain temporarily
🛡️ Step 5: Post-Intubation Airway Protection
- Suction the ETT lumen and trachea prior to initiating positive pressure ventilation to avoid distal contamination.
- Confirm tube placement and cuff seal.
- Monitor for ongoing contamination; consider placing an oropharyngeal drain if high risk for further soiling
🔍 Additional Insights
✅ Training simulations improve comfort with SALAD; repeated practice is key
✅ Video laryngoscopy improves visualization but requires mastery of dynamic suction.
Pre-Flight Checklist
Use this pre-flight checklist to review the key steps and skills of the SALAD technique before heading to the SALAD simulator on one of our pop-up skills labs for some reps and expert feedback.
Airway Skills Lab
Where Technique Gets Locked In
Step up to the practice station and get hands-on! Place your mobile device in the holder, and use voice commands to navigate the training. A step-by-step practice guide is below as an additional resource.
Everything you need is right here—review, practice, repeat—and move on to the next station when you’re ready.
Dive Deeper
Click Here to View This Content
Add these extra skills and gestures to your SALAD technique. Breaking complex tasks into smaller, manageable components can facilitate more effective learning and skill acquisition.
What’s Next
Find Or Click Me
Nice work—you’re through this section! To keep going, scan the QR code on the physical poster at the next station in our pop-up training space to access the next set of digital content. Prefer to stay online? Just click the poster image here to continue your journey.
References
Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management. Christopher W Root a,∗, Oscar JL Mitchell b, Russ Brown c, Christopher B Evers d, Jess Boyle e, Cynthia Griffin f, Frances Mae West g, Edward Gomm h, Edward Miles h, Barry McGuire i, Anand Swaminathan j, Jonathan St Georgek, James M Horowitz l, James DuCanto m. PMCID: PMC8244406 PMID: 34223292
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