Nasotracheal Intubation
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Evaluator
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Student
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Skill Steps
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Verbalizes/demonstrates appropriate infection control precautions
Justifies the importance of exhausting all other airway management options prior to attempting NTI
Verbalizes the importance of topical anesthesia
Atomizes 4% lidocaine in both nostrils (2% can be used)
Inserts airway adjunct (NPA) with 4% lidocaine jelly (2% can be used)
States maximum dose of lidocaine is 3 mg/kg
Oxygenates patient and provides ventilatory assistance, if needed
Gathers and checks intubation equipment, including BAAM
Positions patient (high Fowler’s, neck neutral or slightly flexed)
Removes NPA
Introduces NT tube (lubricated with 4% lidocaine) at 90 degree angle to the frontal plane
Advances NT tube to glottic opening (notes loudest sound from BAAM)
Times further advancement of NT tube to patient’s inspiration and intubates the trachea
Removes BAAM immediately and inflates cuff
Confirms tube placement (must auscultate and use capnography)
Ventilates 8-10 times per minute or in synch with patient’s respirations
Secures tube
Critical Criteria
Failure to initiate ventilations in a timely manner
Failure to successfully intubate the trachea
Failure to disconnect cuff syringe immediately after inflating cuff
Failure to confirm tube placement
Exhibits unacceptable affect with patient or other personnel
Uses or orders a dangerous or inappropriate intervention
Evaluator Comments
Success?
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Pass
Needs Remediation
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