Effective use of video laryngoscopes requires knowledge, skill, and attention to detail to ensure successful intubation and optimal patient outcomes. In this blog post, we’ll share clinical pearls and best practices for using video laryngoscopes, offering valuable tips and insights to enhance operator proficiency and confidence during airway management procedures.

Proper preparation and equipment setup are essential for successful intubation with a video laryngoscope. Ensure that the device is assembled correctly, the video screen is positioned for optimal visibility, and the blade is appropriately sized and angled for the patient’s anatomy. Verify that all necessary accessories, such as endotracheal tubes, stylets, and suction equipment, are readily available and functioning properly. Preoxygenate the patient and administer appropriate sedation or neuromuscular blockade as needed to facilitate intubation.

Proper patient positioning and alignment are critical for achieving optimal visualization and intubation success with a video laryngoscope. Position the patient in the sniffing position with the head extended and the neck slightly flexed to align the oral, pharyngeal, and laryngeal axes. Use gentle external laryngeal manipulation (ELM) to optimize glottic exposure and improve the view of the vocal cords. Maintain a clear line of sight between the video laryngoscope blade and the glottic opening throughout the intubation procedure.

Insert the video laryngoscope blade into the patient’s mouth while applying upward pressure on the mandible to lift the tongue and create space for the device. Advance the blade along the midline until the epiglottis comes into view on the video screen. Use the blade tip to lift the epiglottis and expose the vocal cords, adjusting the blade angle as needed to optimize the view. Avoid excessive force or manipulation of the blade to minimize the risk of trauma to the oral cavity or airway structures.

Once the vocal cords are visualized, carefully advance the endotracheal tube through the glottic opening under direct visualization on the video screen. Maintain gentle upward pressure on the blade to facilitate passage of the endotracheal tube into the trachea. Confirm proper tube placement by observing bilateral chest rise and auscultating breath sounds over the lung fields. Secure the endotracheal tube in place and confirm tube position with capnography or chest X-ray as per institutional protocols.

After successful intubation, provide appropriate post-intubation care, including confirmation of tube placement, initiation of mechanical ventilation, and monitoring for complications such as hypoxia or hypotension. Document the details of the intubation procedure, including the device used, Cormack-Lehane grade, number of attempts, and any complications encountered. Communicate with the healthcare team and transfer care to the appropriate clinical service for ongoing management and monitoring.

Continuous training and education are essential for maintaining proficiency and confidence in using video laryngoscopes for airway management. Participate in regular skills drills, simulation-based exercises, and debriefing sessions to reinforce technical skills and clinical decision-making. Stay updated on the latest evidence-based guidelines, practice recommendations, and advancements in video laryngoscope technology to optimize patient care and outcomes.

Clinical pearls and best practices for using video laryngoscopes are essential for achieving successful intubation and ensuring optimal patient outcomes. By following these tips and insights, healthcare providers can enhance their proficiency, confidence, and effectiveness in using video laryngoscopes for airway management in diverse clinical settings.