UMHC Protected Intubation SOP

LOCATION • ALL intubations MUST occur in a negative pressure room or cohorted ward

• In room (in PPE):

• Primary intubator
• Primary nurse
• RT
TEAM

• Immediately outside room:

• 2nd provider for intubation (in PPE)
• Nurse (not in PPE)
• 1 nurse/provider (not in PPE)
• The primary intubator should be an anesthesia, ER, or ICU attending whenever possible

• In room:
• HEPA filter on: (1) bag-valve-mask & (2) 100% NRB mask
• Glidescope VL (DL back up), 2 ETTs, 2 stylets
EQUIPMENT

• Capnograph, ETT holder, suction, 10cc syringe

• Intubating laryngeal mask airway (LMA)
• Medications for rapid sequence intubation (RSI) – draw up outside room
• Mechanical ventilator with settings preset (enable quick connection)
• Immediately outside room:
• Difficult airway devices (boogie, bronchoscope)

1. Prepare equipment and meds outside of room:

• Intubator(s): prepares 2 ETTs, VL/DL blades, & LMA
• RT: gathers capnograph/ETT holder/bag-mask/ambubag/HEPA filter, sets
ventilator
• RN(s): draws up RSI meds (propofol/etomidate & rocuronium/
succhinylcholine), gathers suction tubing/equipment
2. Team huddle—all team members (in & out of room) to ensure everyone knows roles
3. Don PPE (in room and second intubator who is outside room)
INTUBATION PROCEDURE

• Bunny suit, N95 mask with face mask with shield placed over it, gloves, booties
4. Enter room and explain procedure to patient if awake
5. Prepare to intubate:
• Intubator: set-up VL, position patient
• RT: places 100% NRB with HEPA filter on patient; sets up ventilator (with HEPA
filter); connects ambubag with HEPA filter
• RN: sets up suction & monitor
6. Perform intubation:
i. RN pushes RSI meds
ii. Intubator intubates using VL without bag-mask ventilation if able
iii. If unable to intubate, use intubating LMA (avoid bag-mask if able)
iv. Plan to re-attempt intubation through LMA or with VL/DL/rescue device
v. When successful, attach to ventilator as soon as possible
7. Leave all equipment in the room
8. Exit room and doff PPE
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9. Debrief as a team (all members both in & out of room) reviewed February 2021