How To Realize Medical Tracheal Intubation Practical Training

How To Realize Medical Tracheal Intubation Practical Training?

For medical students, human trachealintubation models are a core tool for standardized, highly realistic, hands-on training. These models are designed and constructed strictly based on normal human anatomy. The head and upper chest wall bones are made of fiberglass to simulate physiological rigidity. Key areas such as the facial soft tissue, mouth, nose, tongue, epiglottis, glottis, trachea, bronchi, esophagus, lungs, and stomach are constructed of soft, elastic rubber plastic, ensuring a precise tactile fit. The model features a movable jaw (supporting oral opening and closing) and a flexible neck joint (allowing the head to tilt back up to 80° and forward up to 15°). It also includes an intubation position indicator and an abnormal operation alarm system, providing precise feedback support for standardized training.

II. Standard Procedures for Oral Tracheal Intubation (Model Training Version)

(I) Pre-Intubation Preparation

Instrument Inspection and Adjustment

Laryngoscope: Confirm that the laryngoscope blade is securely attached to the handle, that the front light is bright enough, and that the illumination direction is accurate.

Tracheal Tube: Use a 10ml syringe to inflate the cuff at the front of the tube (to a pressure of approximately 5-10ml of air). Verify that the cuff is leak-free and completely deflate.

Lubrication: Apply medical lubricant to the tip of the tube and the cuff with a sterile soft cloth. Use a special brush to evenly apply lubricant to the inside of the model trachea to reduce intubation resistance. Positioning the Model

Place the manikin in the supine position. Adjust the cervical joints to tilt the head back and elevate the neck, achieving overlap of the three axes of "oral-pharyngeal-tracheal" and creating optimal anatomical conditions for glottis exposure.

(II) Core Intubation Procedures

Laryngoscope Insertion and Glottis Exposure

The operator stands at the side of the manikin's head. Holding the laryngoscope in their left hand, they slowly insert the laryngoscope blade along the right edge of the tongue dorsum to the base of the tongue. Gently lift the laryngoscope upward (using a lever to avoid using the teeth as a fulcrum), first observing the epiglottis margin. Then, position the front end of the laryngoscope blade at the junction of the epiglottis and the base of the tongue (the optimal position for glottis exposure). Continue lifting the laryngoscope upward to clearly visualize the glottic fissure.

Tube Insertion and Depth Control

Holding the endotracheal tube in their right hand, align the tip of the tube with the center of the glottic fissure and gently insert it into the trachea. After the tube has passed the glottis approximately 1 cm, continue to rotate and advance (add 4 cm for adults and 2 cm for children). The total intubation length for adults is generally 22-24 cm (adjustable based on the "Height" marking on the mannequin). For children, estimate "age/2 + 12 cm."

Post-Intubation Confirmation and Securement

Bite-Tray Insertion: Place a bite-tray between the endotracheal tube and the mannequin's teeth to prevent tube displacement or tooth damage.

Ventilation Verification: Connect the resuscitator to the tube and squeeze the cuff. If both lungs inflate and there is no beeping sound, intubation is successful. If the stomach inflates and there is a beeping sound, immediately remove the tube and retry the procedure.

Securing and Sealing: Secure the tube and bite-tray with 3M medical tape in an "8" pattern. Then, inject an appropriate amount of air into the cuff (5-8 ml for adults, 2-5 ml for children) to ensure a tight seal between the tube and the tracheal wall to prevent air leaks and reflux. (III) Finalization and Model Maintenance

After completing the training, first empty the catheter cuff with a syringe, then remove the mouthpiece and slowly remove the endotracheal tube.

Wipe the model's mouth, trachea, and esophageal passage with sterile saline to remove any residual lubricant. Allow to dry and store properly to prevent degradation of the rubber and plastic components.

III. Key Precautions

When inserting the laryngoscope, avoid excessive pressure on the teeth or tongue. If an alarm sounds, immediately adjust the laryngoscope's position.

If resistance is encountered during catheter insertion, do not forcefully advance. Readjust the head position or laryngoscope angle to ensure glottis exposure before proceeding.

Do not overinflate the cuff (pressure should not exceed 25 cmH₂O) to prevent damage to the tracheal mucosa.

It is recommended to combine advanced scenario training, such as "blind insertion" and "difficult airway simulation," to gradually improve emergency response capabilities.