What are lighted stylet-assisted tracheal intubation devices?
Intubation or endotracheal intubation is a medical procedure in which a tube (endotracheal tube) is placed into the windpipe (trachea) through the mouth or nose. In most emergencies, endotracheal intubation is performed through the mouth.
Lighted stylet-assisted tracheal intubation devices are tube-like devices with a light source at one end. They help in easy and fast intubation by providing support and their shape aids navigation of the endotracheal tube toward the trachea, whereas the light at the end of the stylet guides the correct placement of the endotracheal tube.
Light-guided intubation is simple and effective in many patients. When the tip of the stylet carrying the light source (lightwand) enters the opening of the trachea (glottis), a bright glow can be observed externally on the front of the neck just below Adam’s apple.
By contrast, if the lightwand is placed in the food pipe (esophagus), no such glow on the neck is observed. For a better view of the glow, room lights are dimmed during the procedure.
Various lighted stylets are available for intubation such as Light Wand (Vital Signs Inc, Totowa, NJ), Trachlight (Laerdal Medical, Wappingers Falls, NY) and Tube Stat lighted stylet (Xomed, Jacksonville, FL). Because these devices rely on the principle of transillumination (appearance of a glow on the front of the neck from the lightwand underneath), direct visualization of the glottis is not required for their use.
What is the main use of lighted stylet-assisted tracheal intubation devices?
The main indication is in patients with a difficult airway for whom a direct laryngoscopy (a procedure for visualization of the vocal cords) has failed, for example, a trauma patient with bleeding in the area behind the mouth (oropharynx).
Patients who have been given muscle relaxants (pharmacologically paralyzed) and cannot be intubated with a direct laryngoscopy are also the candidates for light-guided tracheal intubation.
What happens during a lighted stylet-assisted tracheal intubation?
- If the patient is awake, the doctor applies a local anesthetic spray and administers sedation.
- If a neck injury is not a concern, the patient’s head and neck are placed in a relatively extended position (chin-up position) with the help of a towel roll placed under the shoulders. This allows maximal exposure of the front of the neck, thereby enhancing visualization of the transilluminated light.
- If a neck injury is a concern, the patient’s head is placed in a neutral position.
- The practitioner generally stands at the head end of the patient and inserts the lubricated lighted stylet into the endotracheal tube.
- The practitioner bends the tube and stylet in the shape of a hockey stick, with a 90° curve beginning just above the tube cuff.
- They grasp the patient’s jaw near the corner of the mouth using the thumb, index and middle fingers and lift the jaw to elevate the tongue and the covering of the voice box (epiglottis).
- A glow in the midline of the neck indicates the location of the tube tip. Positioning is optimal when the glow can be observed in the midline of the neck, just below Adam’s apple.
- The practitioner then slides the endotracheal tube off while holding the stylet steady and advances into the trachea up to the proper depth.
- The doctor confirms the tube placement by using a stethoscope and capnography (measurement of carbon dioxide in a patient’s exhaled breath).
- Finally, the doctor secures the endotracheal tube with a tube holder or an adhesive tape.
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