Reviewed and revised 12 Feb 2014
- digital intubation allows intubation to be performed without a laryngoscope or a view of the larynx
- may be performed with or without a bougie
- Cramped environment (e.g. patient trapped in vehicle)
- Copious oral fluids (e.g. large amount of blood or vomitus in oral cavity, obscuring visualization with a laryngoscope)
- Inability to visualize vocal cords with laryngoscope
- Severe head/ neck trauma requiring immobilization of cervical spine
DESCRIPTION OF PROCEDURE
Blind digital intubation without a bougie
Technique of bougie-assisted blind digital intubation (from Rich, 2008)
- After the epiglottis is identified by palpating it with the long finger of the left hand, the bougie is threaded through the glottis and advanced into the trachea. Tracheal clicking elicits tactile vibrations, which confirm tracheal placement of the bougie.
- The bougie is withdrawn slightly so that the 25-cm mark is at the corner of the lip. The endotracheal tube is threaded over the bougie while the bougie is stabilized in place.
- With the bougie held in place, the endotracheal tube is turned a quarter turn to the left and then advanced to an appropriate depth.
- The tube is held in place while the bougie is withdrawn. Tracheal intubation is then confirmed using capnography or an esophageal detector device.
- Fast (in experienced hands)
- No requirement for optimal positioning
- Minimal c-spine movement for trauma patients
- Ideal for those predicted to be difficult airway (eg. underbite, short neck, obese)
- Can be used if copious secretions/blood in airway and cannot visualize landmarks
- Requires training (cadaver or sim lab)
- Risks operator trauma from patient’s teeth
- Airway trauma
- Patient must be paralyzed or comatose/dead
- Benefits operators with long, slender fingers
References and Links
- Hardwick WC, Bluhm D. Digital intubation. J Emerg Med. 1984;1(4):317-20. PubMed PMID: 6501845.
- Rich JM. Successful blind digital intubation with a bougie introducer in a patient with an unexpected difficult airway. Proc (Bayl Univ Med Cent). 2008 Oct;21(4):397-9. PMCID: PMC2566913
- Stewart RD. Tactile orotracheal intubation. Ann Emerg Med. 1984 Mar;13(3):175-8. PubMed PMID: 6696305.
- Vacanti CA, Roberts JT. Blind oral intubation: the development and efficacy of a new approach. J Clin Anesth. 1992 Sep-Oct;4(5):399-401. PubMed PMID: 1389195.
- Young SE, Miller MA, Crystal CS, Skinner C, Coon TP. Is digital intubation an option for emergency physicians in definitive airway management? Am J Emerg Med. 2006 Oct;24(6):729-32. PubMed PMID: 16984845.
FOAM and web resources