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Video Laryngoscopy

Lights, Camera, Action!

An instructional graphic about video laryngoscopy, featuring a close-up of a hand holding a video laryngoscope, highlighting its importance in airway management and visualization during intubation.

The Essentials

Watch this step by step video and review the sequence below

Step-by-step guide for video laryngoscopy procedures, detailing essential positioning and techniques for optimal tube delivery and insertion.

The Procedure

  • Preparation
    • Stand at the head, adjust the bed height for comfort (at or around your umbilicus).
    • Patient sniffing/ear-to-sternal-notch, head midline, mouth accessible
    • Laryngoscope in left hand, tube + stylet in right hand
  • Open the mouth
    • Use your right hand scissor: thumb on lower incisors/mandible, index on upper incisors/maxilla, spread to open
    • If needed, pull the mandible down and forward to enlarge the oral aperture
  • Insert the blade
    • Insert the blade midline in the mouth
    • Control the tongue as you advance
    • Keep the blade midline once past the teeth
  • Advance to your target
    • Macintosh: advance until the tip sits in the vallecula
    • Miller/straight: advance until the tip is under the epiglottis
  • Lift to expose the larynx
    • Lift up and away in the direction of the handle axis (toward the ceiling corner), no levering on teeth
    • Small adjustments: slight withdrawal, re-center midline, increase mouth opening, optimize lift vector
  • Optimize the view (pure mechanics)
    • Maintain lift, then use one of:
      • External laryngeal manipulation (your right hand or assistant) to bring the cords into view
      • Slight blade depth change (too deep vs too shallow)
  • Deliver the tube
    • Bring tube in from the right corner of the mouth
    • Keep the tube out of your line of sight, then advance toward the cords
  • Pass the cords and seat
    • If cords there is hangup rotate tube clockwise to help it pass (as needed)
      • Advance until the cuff is beyond the vocal cords
      • Stop at typical depth: ~21 cm (women), ~23 cm (men) at teeth/lip (adjust for patient size)
  • Remove hardware in sequence
    • Hold tube steady
    • Withdraw the laryngoscope carefully
    • Remove stylet without moving tube position
    • Inflate cuff
  • Quick mechanical checks
    • Tube secured at recorded depth
    • Device removed, mouth clear, tube in place, ready for confirmation.

What’s Next

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Infographic on the essentials of optimizing endotracheal intubation, highlighting key steps like manipulation, size and type of laryngoscope blades, adjuncts, suction, oxygen, sedation, and paralysis.

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