No Bend. All Control.
The Essentials
The Rigid Stylet is designed for hyperangulated video laryngoscopy, featuring a preformed shape that matches the blade’s curvature for precise, controlled tube delivery. Its rigid build and ergonomic handle offer predictability and ease of use, but require proper technique.
It’s also, as the name implies, rigid. This means that what you see is what you get, so don’t try to shape it like a standard flexible stylet or push it past the cords into the trachea. It won’t bend and can cause tracheal injury.
The Steps Towards Mastery
One thing that’s easy to miss with hyperangulated blades? Success often hinges on mastering a second tool—the rigid stylet. This isn’t the soft, bendy stylet you’re used to. It’s stiffer, less forgiving, and it asks for a different set of skills. But once you dial in the technique, tube delivery gets smoother, faster, and way more reliable. Use this space to get familiar with this important component of HAVL success. Here’s what you need to know.
Complete Guide to the Rigid Stylet
The Essentials
Key Differences of the Rigid Stylet vs Standard Flexible Stylet
- Pre-formed: Does not require shaping.
- Distal Angle: matches the HA blade’s angle and follows its curvature.
- Handle: facilitates control and retraction of the stylet.
- Removal: requires following the stylet’s shape to avoid dislodging the tube.
Deep Cuts
Mastering the hyperangulated blade also requires getting comfortable with a rigid stylet, an often-overlooked requirement. The rigid stylet differs from the stylets you may be familiar with, requiring new skills to achieve effective tracheal access and efficient tube delivery. This deeper dive into the device is worth the 7 minutes.
Advanced Technique
To Optimize Your Efficiency
As you gain confidence with the rigid stylet, your focus should shift to optimizing movement efficiency and streamlining your technique. While there are many ways to use a rigid stylet, some are more effective than others. Here, we teach the palm-up technique, as demonstrated in the video. Please take a moment at this station to practice it until it feels natural. Once comfortable, please bring it to the hands-on station and integrate it into your hyperangulated video laryngoscopy workflow.
A tip from Dr. Richard Cooper: If your tube stalls in the posterior oropharynx, don’t rotate the stylet handle back—lift up instead! This simple move aligns the tube with the trachea and improves delivery by leveraging airway geometry and spatial relationships. For a deeper dive, we recommend the full video with Dr. Cooper and Dr. Chrimes from the Safe Airway Society.
Great Moments in PAC History
thumbs up – Tube Delivery
One of our favorite moments from PAC20 was tube delivery, Hawaiian Style 🏄♂️🌈 🤙 with Jim DuCanto, MD @jducanto. Don’t forget to add him to your learning network.
Time to Practice!
Step Into the Training Lab
This guide is part of our digitally enhanced, hands-on curriculum built to help you master hyperangulated video laryngoscopy. Step up to the practice station, place your mobile device in the holder, and use voice commands to move through the training at your own pace. Practice core skills as many times as you need—in a judgment-free zone designed for learning. There’s no better way to improve than by getting in the reps and troubleshooting independently. When you’re ready, check in with one of our expert faculty for real-time feedback and a final review of your technique.
Guided Video
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.
Guided Audio
Listen Here
Deep Dive
MicroSkills: Breaking it Down
Step up to the practice station and get hands-on. Watch the video above and use the checklist below to lock in the key skills and clinical pearls for mastering the hyperangulated blade. Everything you need is right here—review, practice, repeat—then move on to the next station when you’re ready.
Click Here for a Breakdown of Rigid Stylet Skills
Skill 1: How to Hold the ETT With Rigid Stylet
Checklist:
- Hold in your RIGHT hand.
- Hold at the top of the tube
- Palm Up Technique
- Avoid gripping too tightly.
Media Placeholder: [Insert short video or GIF here demonstrating proper blade hold]
Skill 2: Insertion into the Mouth
Checklist:
- Look in the mouth
- Insert tube RIGHT side of mouth
- Advance around the tongue
Media Placeholder: [Insert short video or GIF here demonstrating proper blade hold]
Skill 3: Delivery to the Glottis
Checklist:
- Eyes on the screen as the tube advances.
- Deliver to the glottic opening.
Media Placeholder: [Insert short video or GIF here demonstrating proper blade hold]
Skill 4: Accessing the Trachea
REMEMBER: Getting your tube into the trachea from this point means understanding the limits of your rigid stylet. It’s fixed, so trying to push past the glottis will only cause a hang-up or worse. The same curve that helped you reach the glottic opening isn’t designed to go much farther, especially past the subglottic space.
To deliver the tube smoothly and safely, you’ll need to use a simple, memorable technique: stop, pop, and drop. That means you stop advancing once the tip of the tube is at the cords, pop the tube slightly off the stylet to loosen the tip, and drop your hand to the right to let the tube follow the natural curve of the trachea. This maneuver softens the distal end, aligns the tube with the tracheal axis, and helps it glide in without resistance or injury. It’s a small move that makes a big difference.
Subskill A: Stop
- Do not push beyond the glottis
- STOP to avoid a hang-up or tracheal injury to your patient.
Media Placeholder: [Insert short video or GIF here demonstrating proper blade hold]
Subskill B: Pop
- Use your thumb to POP the handle
- Retract the stylet
Media Placeholder: [Insert short video or GIF here demonstrating proper technique]
Subskill C: Drop
- Drop your hand holding the tube down and to the right (clockwise).
- This will align the distal tip of the tube with the tracheal axis.
Media Placeholder: [Insert short video or GIF here demonstrating proper technique]
Subskill D: Lift
- Don’t rock back, lift up
- Lifting the tube off the posterior oropharynx will help align the tube tip with the tracheal axis.
Media Placeholder: [Insert short video or GIF here demonstrating proper technique]
Before You Leave
Don’t underestimate the value of breaking down and practicing these microskills for HAVL. Before you go, make sure you can do the following:
- Hold the tube with the rigid stylet towards the top (proximal end)
- Don’t push past the cords. STOP/POP/DROP
- Follow the curve of the stylet to remove safely
Troubleshooting Tips
Stop-Pop-Drop
The Bottom Line
The rigid stylet is an essential companion to the hyperangulated video laryngoscope, precisely engineered to mirror the blade’s curvature and guide the endotracheal tube along a reliable path to the glottis. Unlike flexible stylets, which require manual shaping and can bend or deform during use, the rigid stylet provides a consistent, preformed structure that streamlines setup and enhances control during tube delivery. While its fixed shape requires adjusting your approach to tracheal access, with a few key skills and deliberate practice, clinicians can confidently transform excellent glottic views into successful intubations. Mastery of the rigid stylet is a critical step in unlocking the full potential of hyperangulated laryngoscopy.
Visit the Next Poster
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.
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