Lighted Stylet Assisted Tracheal Intubation Technique

Updated: Feb 25, 2019
  • Author: Liudvikas Jagminas, MD, FACEP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
  • Print
Technique

Tracheal Intubation With Lighted Stylet

Procedure

The practitioner should stand at the head of the patient. If this is not possible, the patient can be approached from either side.

Insert the lubricated lighted stylet into an endotracheal tube 2.5 mm or larger (pediatric stylets are available) until the bulb lies just distal to the Murphy eye but does not protrude from the end of the tube. Bend the tube and stylet in the shape of a hockey stick, with a 90° curve beginning just proximal to the tube cuff. [1, 2]

Place the patient's head and neck in the neutral position or slightly extended. Grasp the patient's jaw near the corner of the mouth using the thumb, index, and middle fingers. Lift the jaw to elevate the tongue and epiglottis. (See the video below.)

Tracheal intubation (lighted stylet). Video courtesy of Therese Canares, MD, and Jonathan Valente, MD, Rhode Island Hospital, Brown University.

A glow in the midline of the neck indicates the location of the tube tip (see the image below).

Trachlight anterior neck. Image courtesy of Lawren Trachlight anterior neck. Image courtesy of Lawrence B Stack, MD (http://www.lbstack.com/).

Applying cricoid pressure and dimming the lights may enhance transillumination. Positioning is optimal when the glow can be seen in the midline of the neck, just below the level of the thyroid prominence.

Next, slide the endotracheal tube off while holding the stylet steady, and advance into the trachea up to the proper depth. If the glow is located off midline, withdraw the unit 2 cm and reposition as indicated by the light. If no light or only a dim light is seen, the tube is probably in the esophagus. If this is the case, withdraw the tube, apply cricoid pressure, and, if necessary, extend the head slightly.

Once the lighted stylet has been removed and the tube placement has been verified by means of auscultation and capnography,  secure the endotracheal tube with a commercially available tube holder or adhesive tape. [1, 6, 2]

​Pearls

Some authors suggest that for novices, conventional laryngoscopy may be superior to the use of transillumination with a lighted stylet. However, for practitioners experienced in its use, transillumination can be as reliable as conventional laryngoscopy, and it can be used in apneic patients.

Positioning is correct when the glow emanates from the midline, just below the level of the thyroid prominence. In extremely thin patients, transillumination may be seen even when the tube is the esophagus. To tell the difference, note that if the tip is in the esophagus, the glow is diffuse, as opposed to the well-circumscribed glow of intralaryngeal placement.

A controlled study by Muslu et al highlighted the successful use of ultrasonography (US) as an adjunctive method for tracheal tube placement confirmation within 3 seconds of intubation in 150 adult surgical patients. [17] In this study, tracheal tube position was successfully identified by means of US in 75 of 75 tracheal placements and 75 of 75 esophageal placements, for a sensitivity of 100% and a specificity of 100%.

Next:

Complications

No complications directly related to the use of the tracheal light have been cited in the literature; this may be a reflection of the relatively limited use of this technique. [1, 2]

Previous