RHC PICU INTUBATION CHECKLIST

Equipment
Access & Safety
Child & Team
Drugs Netting
Monitoring

Previous grade of Continuous monitoring Working IV Access? Who is . . .?  Apnoiec oxygenation?

intubation  Tone on (nasal cannula oxygen @
 Ensure no blockage to  Team Leader 2L/kg/min)
 SaO2
Patient fasted?  End tidal CO2 flow (eg BP cuff on
 1st Intubator  Is there a known difficult
 ECG different limb)
Pass NG & aspirate  2nd Intubator airway?
 BP (1 min)
o Different limb to SaO2  If no IV access
Pre-oxygenate Equipment  Cricoid Pressure  Do you need to consider:
 ? IO
o T piece & mask  ? ‘Gas down’ o ‘Gassing down’
 Intubator’s Assistant
Patient’s condition o Do ENT/anesthetics
o Guedel/NPA/LMA  Drugs need to be present or
optimised? Drugs (See over for doses)
o 2 working nearby
 NG Aspirator
sPine stable?  Sedation
Laryngoscopes  CPR (if required)  If unanticipated difficult
Positioning o ET tubes - size +/- 0.5  Paralysis airway, how will you
 Nurse in Charge maintain oxygenation
(?neck roll/pillow)  Resuscitation
o Magill’s forceps aware (plus A,B,C,D)?
o Introducer or bougie  Infusions
 Back up team:
o Suction & Yankauer Team Leader to vocalise plan o Anesthetics on call
Volume
o NG tube & aspirated  NaCl 0.9% 10-
 Any other anticipated
o Syringe for cuff 20ml/kg problems?
o Tinc Benz & Tapes  PPS 10-20 ml/kg
o Stethoscope

Team Leader & Primary Nurse are responsible for ensuring checklist complete prior to carrying out intubation
Version 4.5
Used intubation equipment should not be placed back on intubation trolley Feb ‘19
 NB. Enter a weight on CIS & it will calculate resuscitation drug doses

INTUBATION DOSE (IV) Onset of Duration COMMENTS Resuscitation Drugs DOSE

DRUGS Action of Action Adrenaline 0.1ml/kg of 1:10,000
(All can also be (Mins) (Mins)
given IO)
Anesthetic Drugs
Atropine 0.02mg/kg
(min dose 0.1mg)
Ketamine 2mg/kg/dose <1 10-15  Good for patients in septic shock ( BP)
Calcium Chloride 10% 0.2 mmol/kg
 Increases secretions
Fentanyl 2-10 1-3 20-60
mcg/kg/dose Sodium Bicarbonate 1-2 mmol/kg
8.4% * Through separate line
Neuromuscular
Blockers Adenosine 150 –
Vecuronium 0.1 - 0.2mg/kg 1-3 20-40  Caution in severe hepatic and renal failure 500mcg/kg/dose
*Quick flush afterwards
Rocuronium 0.6 – 1mg /kg 1 20-40  Caution in severe hepatic and renal failure Amiodarone 5mg/kg over 3 mins
(VF/pulseless VT dose (max 300mg)
Suxamethonium 1 – 2mg/kg 0.5-1 3-5  Can cause bradycardia only)
 Can cause K+(avoid in burns patients, Joules 4J/kg (external pads)
renal failure) 0.5J/kg (internal
paddles)
Sedative Drugs
Volume 10 – 20 ml/kg
Midazolam 50-100 2-5 30-120  Hypotension if administered quickly NaCl 0.9% or
mcg/kg/dose
Albumin 5% or O –ve
Morphine 50-100 2-5 60-240  Hypotension if administered quickly blood (in theatre
mcg/kg/dose
fridges)
Sugammadex 16mg/kg
Calculations
(Rocuronium reversal)
ET Size: [Age (yrs)/4] +4

ET Length:
Oral – Age/2 +12
Nasal – Age/2 +15 Version 4.5
Jan ‘19