ETT Stylet
OVERVIEW
- ETT stylet is a device that allows the endotracheal tube (ETT) to be stiffened and the shape molded as desired.
USE
- alters the shape of an ETT to facilitate intubation
- stiffens the ETT to aid passage into the trachea
DESCRIPTION
- curved proximal tip that hooks over the end of the universal connector to prevent the distal stylet tip from extending beyond the tip of the ETT
- Polyethylene coated malleable aluminum
- Single use available in different lengths appropriate for different tube sizes
METHOD OF INSERTION/ USE
- lubricate stylet with water soluble gel
- insert stylet into ETT
- bend the stylet into the desired shape
- optimal shape for intubation direct laryngoscopy is ‘straight-to-the-cuff’ with a a ‘hockey stick’ bend at the cuff of no more than 35 degrees
- ETT is inserted from the right side of the patient’s mouth to maximise your view and provide optimal control of the position of the tip of the endotracheal tube
COMPLICATIONS
- Trauma due to protrusion of the stylet tip beyond the end of the ETT
- inadvertent removal of the ETT when removing the stylet
OTHER INFORMATION
- different brands and sizes available, including pediatric sizes
- if a stylet is used for video laryngoscopy different conformations may be optimal depending on the type of video laryngoscope/ blade
- traditional arcuate shaped stylets/ ETTs may obscure the view of the ETT tip on insertion and cause the tip of the ETT to abut against the inner surface of the anterior trachea once the passed through the cords
This video by Levitan/ Airwaycam.com shows the benefit of the straight-to-cuff stylet shape:
Stylets and bougies by Tim Leeuwenberg:
References
- Levitan RM, Pisaturo JT, Kinkle WC, Butler K, Everett WW. Stylet bend angles and tracheal tube passage using a straight-to-cuff shape. Acad Emerg Med. 2006 Dec;13(12):1255-8. PMID: 17079788.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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