240 Section VI ■ Respiratory Care

is resting in the vallecula (the area between the base of

the tongue and the epiglottis) (Fig. 36.6).

In general, the blade tip should be placed in the vallecula. However, in extremely premature infants, the

vallecula may be too small, in which case it may be necessary to use the blade tip to gently lift the epiglottis.

9. Lift the laryngoscope blade to open mouth further and

simultaneously tilt the blade tip slightly to elevate the

epiglottis and visualize the glottis (Fig. 36.7).

When lifting the blade, raise the entire blade in the

direction that the handle is pointing. Do not lift the tip

of the blade by using the upper gum line as the fulcrum for a rocking motion; this will not produce a clear

view of the glottis and will place excessive pressure on

the alveolar ridge, potentially impeding future tooth

formation.

10. Suction as necessary.

11. Have an assistant apply gentle pressure at the suprasternal notch to open the larynx and to feel the tube pass

(12).

12. Hold tube in right hand with concave curve anterior,

and pass it down the right side of the mouth, outside

the blade, while maintaining direct visualization

(Fig. 36.8).

13. Once the vocal cords and trachea are visualized, insert the

endotracheal tube through vocal cords, approximately

Fig. 36.8. Visualize the glottis and pass the endotracheal tube

into the oropharynx. Keep the tube outside the curve of the laryngoscope blade for better mobility.

Fig. 36.7. With the laryngoscope at the proper depth, tilt the

blade with the tongue as the fulcrum; at the same time, pull on

the laryngoscope handle to move the tongue without extending

the infant’s neck. Use more traction than leverage.

Fig. 36.5. Open the mouth and push the tongue aside with the

forefinger, while stabilizing the head with the thumb and other

fingers of the right hand.

Fig. 36.6. Pass the laryngoscope carefully along the finger to

the back of the oropharynx.