Intubation question.

[itku2er]

We were having a discussion in the chatroom about the techniques of intubating a patient. We have all been taught to hold the scope in our left hands, but could you hold it in your right hand and get the same effects as you do your left? I am running on Sunday or suspose to anyway so I am going to try it. Just wondering if you all have any thoughts on this.

Edited by me so I can clarify I wont be trying it on a live person....lol

Edited November 4, 2009 by itku2er

[akflightmedic]

We were having a discussion in the chatroom about the techniques of intubating a patient. We have all been taught to hold the scope in our left hands, but could you hold it in your right hand and get the same effects as you do your left? I am running on Sunday or suspose to anyway so I am going to try it. Just wondering if you all have any thoughts on this.

Edited by me so I can clarify I wont be trying it on a live person....lol

Which side of the blade is your bulb on, you know that little light that assists you in seeing where you need to be?

(hint: it is on the right)

So if you held the blade in your right hand and then performed proper insertion technique, where would your light be aiming? Would you have enough light to see?

Not so sure....

[fireflymedic]

Also, depending on the blade you use (especially if mac or grandview is your blade of choice) the way the blade is formed will obstruct your vision, plus you will be sweeping the tongue right not left. I am left handed so it took some adjustment for me to be comfortable using my right to intubate, but rather than sweep right or trying to insert over my left with obstructed vision I learned. For a miller I don't know how it will play, but I would say quite similar. I guess you could make it happen, especially if you utilized a bougie, but otherwise I'd say it won't work.

Edited November 4, 2009 by fireflymedic

[VentMedic]

Intubation equipment is commonly designed for the right handed person. Since the world basically evolves around the right handed, left handed people are usually ambidextrous. Some left hand doctors do have their own left handed blades. And, left handed blades are also used by some right handed people for difficult intubations involving some type of mass or oral surgery if a flex scope is not necessary. We do keep a left handed Mac 3 and 4 on the main difficult airway cart, the OR and the bronchoscopy lab especially if teaching or videotaping.

However, for someone just switching hands for the heck of it, the blade design and light may be a hindrance as akflightmedic already posted. Of course there are also intubations and procedures that can be done where the light source and support of the blade is used but it is not the primary intubation device. That technique may even be required when doing an assisted flex scope intubation.

Edited November 4, 2009 by VentMedic

[FireMedic65]

Not going to repeat how right previous posts are, there is no sense in that.

I just wanted to say, that I have tried to do left handed intubations (on an airway manikin) a few times just to see how it would be. It is hard to see because of the light, but it is still easily possible.

edit: Also, being left handed, and learning how to tube right handed, it wasn't a problem. Trying lefty felt a little weird, but it was still possible to insert the tube properly.

Personally, it should be up to the provider on which way they wish to do the technique. Do all surgeons have to hold a scalpel with their right hand? No, probably not. Yes, I know scalpels are universal

Edited November 4, 2009 by FireMedic65

[AnthonyM83]

I can't see that working better than right handed, unless you're doing face-to-face intubation or working with some really messed up airway anatomy.

[VentMedic]

There is also the issue if you did do damage to the patient when intubating, you might have to justify why you are using a piece of equipment in a way other than what it was designed and how you were trained.

[EmergencyMedicalTigger]

I agree with previous posts. Just to throw this comment out there...What about fiber optic blades? They put out plenty of light, illuminating the entire airway no matter what position the blade is in at the time. This could possibly make intubation more feasible with the opposite hand.

[AnthonyM83]

It might then become easier, but depending on the blade, the little shelf it creates to one side also helps you visualize your tube better as it goes down. (Some more or less than others)

[Arctickat]

Blades with a right handed flange are available for the left handed practitioner as are Miller blades with bulbs on the right or left side. My thoughts though are thus:

It requires greater dexterity to manipulate the tube into position than is required to hold the laryngoscope in place. Therefore, the most dominant hand would likely be the best option for placing the endotracheal tube. For the right handed person, the hand with the greatest dexterity would be right hand.

Attempting to place a tube left handed using a Mac blade with a left side flange would be difficult at best and a risk to patient care at worst. As mentioned, if one is left handed and incapable of functioning with a blade designed for those with right hand dominance, there are blades available.