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.

It Involves Six Key Steps

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.

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.

Detailed Review

🔧 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: 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.

Self-guided practice tools are integrated seamlessly into our digital content and can be used in our pop-up training labs or live in-person events to help guide your mastery of key procedures. Here’s how 👇

Step up to the equipment nearby and practice your SALAD technique using this guided audio tool:

1. Place your mobile device in the holder
2. Insert your headphones
3. Begin your guided practice

You hold the suction catheter with an overhand grip in SALAD because the catheter is not just a vacuum tube. It is an active airway instrument.

The grip mirrors the way the laryngoscope is held in the left hand. That visual and physical symmetry matters. In SALAD, the laryngoscope and suction catheter are co-equal tools with different but equally important jobs. The left hand develops the view. The right hand manages the contamination. One hand exposes. The other clears. Both are essential.

The overhand grip gives the right hand better control, leverage, and precision. It allows the clinician to use the rigid suction catheter to displace the tongue, open working space, sweep contamination away from the blade path, protect the view, and guide the catheter into the hypopharynx where it can continuously drain blood, vomit, or secretions.

A loose fingertip grip treats suction like an accessory. The overhand grip treats it like an airway tool.

That is the deeper lesson of SALAD: suction is not secondary to laryngoscopy. It is part of the procedure. The right hand is not waiting for the left hand to finish. The two hands are working together from the beginning.

The overhand grip turns suction into a controlled procedural instrument and reinforces the core SALAD principle: the laryngoscope and suction catheter are different tools, but they belong in the airway together.

In a flooded airway, the tongue, soft tissue, blood, vomit, and secretions all collapse into the same visual field. If you simply insert the laryngoscope into that mess, the blade and camera can get contaminated immediately. You may lose the view before you ever find the anatomy.

The suction catheter solves two problems at once.

First, it clears contamination from the mouth and oropharynx.

Second, because it is rigid and controlled with an overhand grip, it can act like a second airway instrument. It can press the tongue down, open the mouth, lift or distract the mandible slightly, and create a channel for the laryngoscope to enter. That means the blade is not fighting blindly through pooled fluid and collapsed soft tissue. The suction catheter goes first, opens the path, and clears the path.

This is especially important in video laryngoscopy. The camera needs a clean optical field. If the lens is buried in secretions or dragged through vomit, the screen becomes useless. By using the suction catheter to depress, displace, and clear before and during blade insertion, you protect the view before you need it.

The deeper point is that the suction catheter is doing airway geometry, not just airway cleanup. It helps shape the mouth and pharynx into a workable space so the laryngoscope can do its job.

At this point in the SALAD sequence, the suction catheter has already done its first job: it has cleared the mouth, opened the path, and helped the laryngoscope establish a view.

Now it needs to do its second job: stay out of the way while continuing to work.

The left-side “park” position does several things at once.

It keeps suction running in the hypopharynx or proximal esophagus, where ongoing vomit, blood, or secretions are likely to pool or reappear. Published descriptions of the SALAD “Park Maneuver” describe parking the catheter so it can provide continuous suctioning of the hypopharynx during the rest of the intubation attempt. 

“Park the suction catheter on the left side of the laryngoscope to keep continuous suction working in the hypopharynx while freeing the right side of the mouth for tube delivery.”

It also clears the right side of the mouth for tube delivery. Once the catheter is moved to the patient’s left side, the operator’s right hand can release the suction catheter and deliver the endotracheal tube, bougie, or styleted tube through a cleaner working channel. One procedural description notes that after the catheter is positioned on the left, the laryngoscope can be slightly rotated leftward to open space on the right side of the mouth for the endotracheal tube. 

The other important point is that parking does not mean stopping. The catheter is parked because it continues to drain contamination while the clinician focuses on tube delivery. That is the whole logic of SALAD: suction remains active while laryngoscopy and intubation continue

“The SALAD pinch is a right-hand micro-adjustment maneuver. Use the right hand to gently pinch or nudge the laryngoscope blade, making small corrections in blade position to improve the view, protect the working space, and facilitate tube delivery without losing control of the contaminated airway.”

The SALAD pinch is a small, practical adjustment maneuver used when the suction catheter and laryngoscope are already working together in the mouth.

After the suction catheter has been moved into position, the operator can use the fingers of the right hand to briefly pinch or contact the laryngoscope blade and make subtle adjustments to its position. This allows the clinician to fine-tune the blade angle, depth, rotation, or pressure without fully abandoning suction control or restarting the laryngoscopy attempt.

In a contaminated airway, small changes matter. A few millimeters of blade movement can improve the view, lift tissue out of the way, protect the camera lens, or create a better path for the tube. But if the operator lets go of the suction entirely or withdraws to reset, the airway may flood again. The SALAD pinch gives the clinician a way to make those small blade corrections while staying engaged in the two-handed technique.

It also reinforces the larger principle of SALAD: the right hand is not passive. It is constantly helping manage the airway field. Sometimes that means suctioning. Sometimes it means displacing tissue. Sometimes it means parking the catheter. And sometimes it means using the right hand to help fine-tune the laryngoscope so the left hand does not have to solve every positional problem alone.

“The SALAD Poke is a right index-finger maneuver used after the suction catheter is parked left. The operator “pokes” into the right side of the mouth to create space, move the tongue, shift the laryngoscope toward midline if needed, and open a delivery channel for the bougie or endotracheal tube. It is not a big movement. It is a small, deliberate correction that prevents the right corner of the mouth from becoming too crowded during tube delivery.”

he SALAD Poke is a right-hand maneuver used late in the SALAD sequence to create space for tracheal tube delivery.

After the suction catheter has been moved from the right side of the laryngoscope to the left side and parked in the hypopharynx or proximal esophagus, the right hand becomes available to help deliver the tube. But there is a common problem: during laryngoscopy, the blade and hand position can crowd the right side of the mouth, leaving too little room to pass the endotracheal tube or bougie cleanly.

The SALAD Poke solves that problem.

The operator uses the right index finger to enter the right side of the oropharynx and gently create a working channel for the tube. The maneuver can also help move the laryngoscope slightly toward the midline, opening the right corner of the mouth and giving the tube a better path toward the laryngeal inlet. EMCrit’s SALAD description explains that the maneuver is intended to create space for tracheal tube delivery by moving the laryngoscope toward the midline and overcoming the tendency to crowd the right corner of the mouth. 

In Jim DuCanto’s teaching, the SALAD Poke is part of the practical choreography of the technique: suction is parked and still working, the view is maintained, and the right index finger helps expose the delivery path for the bougie or tube. A linked teaching transcript describes leaving suction in place, exposing the larynx, and using the index finger to create space for tracheal tube delivery, which DuCanto calls the S.A.L.A.D. poke. 

Here is the complete microskills video with extra clinical pearls and gestures to add to your SALAD technique. Breaking complex tasks into smaller, manageable components can facilitate more effective learning and skill acquisition.

SALAD can also be modified for supraglottic airway device (SAD) placement. You can run through the modifications here and practice at the training station.

Rapid Review

Full Video