ENDOTRACHEAL INTUBATION CHECKLIST FOR ADULTS & CHILDREN NICU/ NTICU/ NHDA

This checklist should be completed before the intubation procedure.

The difficult airway box should be available for all intubations.

PATIENT “SOAP ME” PROCEDURE

 Explain the procedure to the SUCTION on & connected Zero minus 10 min PREPARATION
patient
 Inform the consultant, parent team OXYGEN connected to Bain circuit Zero minus 5 min PRE-OXYGENATE
and relations.  Set ventilator in PSIMV mode with
 Check previous anaesthetic record AIRWAY EQUIPMENT 100% O2 & PEEP of 5
for difficulty of intubation  Laryngoscopes handles -2 OR
 Ensure good IV access and start  Consider short handle L’scope for  100% O2 via Bain’s circuit for 3 min
preloading with 20ml/kg of obese patients  In children use Ayres T-piece
Plasmalyte or RL  L’scope blade- #3, 4
 ETT- 2 sizes, cuff checked Zero minus 3 min PRETREATMENT
TEAM  Oropharyngeal airways
 2% Xylocard 1.5mg/kg
Identify team members  LMA #3 and 4
 Stylet Zero minus 2 min POSITION
Assign team leader  Bougie
 Patient pulled up to the top of the
 Will direct team  Difficult airway kit
bed
 Will take over in case of difficulty
PHARMACOLOGICAL AGENTS
 Intubation pillow under the head
Airway  Anxiolysis & amnesia-  Head in sniffing position (if C-spine
 One who intubates o Adults Midazolam 2-4mg cleared)
o Child 0.05-0.1 mg/kg  Ramp if obese
Drugs (Nurse)  Opioids- Fentanyl 1-2mcg/kg  Aspirate NG tube and leave on free
 Concentrates only on medications o Give 1mcg/kg initially drainage
o Then 1 mcg/kg post  Keep key of bed for tilting
Cricoid pressure intubation  Space around ventilator and bed for
 Follows team leaders directions  Induction agent- easy movement
o Ketamine 1mg/kg
Manual inline stabilization + Zero min DRUGS IN THIS ORDER
 If C-spine not cleared o Propofol 1-2mg/kg  Midaz, Fentanyl, Ketamine,
 Muscle relaxant – Omit in Propofol
Monitor (Nurse) MG/GBS  Check for chest rise on ventilation &
 To alert if o Scoline 2mg/kg EtCO2 trace
o SpO2 < 90%  If Se K >5.5 call
 Scoline
o NIBP < 90 systolic consultant
o Loss of EtCO2 waveform o Rocuronium 1.2 mg/kg
after ETT placement  Omit if Zero plus 45 sec PLACEMENT
anticipated  Laryngoscopy & intubation
Logistics (Runner) difficult airway  EtCO2 confirmation
 One who can get things if needed  2% Xylocard 1.5mg/kg  Secure ETT
 Vasoactive drugs-
o Ephedrine 6mg/ml Zero plus 2 min POST-INTUBATION
PAEDIATRIC SIZES o Adrenaline 100mcg/ml  Initiate mechanical ventilation
Uncuffed Tube
 Continue all other ongoing  Give Fentanyl 1mcg/kg
At Birth: # 3.5
inotropes  Vecuronium as needed
At 1 year: # 4
 Vecuronium 0.1 mg/kg for adults  Sedation & analgesia infusion
>2 years: Age/4 + 4
and children
Cuffed Tube: Uncuffed tube size – 1
Depth of insertion: ETT size X 3
MONITORING EQUIPMENT * See reverse for predictors of
L’scope blade: < 1yr- # 1(straight)
 SpO2, ECG difficult intubation
>1yr- #2 curved or straight  NIBP Q1min
 EtCO2 mandatory