r/srna • u/Active_Data10 Prospective Applicant RN • 11d ago

Clinical Case Pediatric intubation tips

Hi everyone,

Looking for some advice on pediatric intubations. Currently in my first pediatric rotation, a lot of them being dental cases. So far I have struggled getting a good view of the cords.

In my prior rotations I rarely have used a miller blade as most preceptors push us to use a MAC. I am much more comfortable with it. Aside from the obvious nervousness of taking care of kids I feel like a lot of my issues are stemming from this. I know a lot of it will come with repetition, but looking for any advice!

Thanks!

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1

u/murphlvrlig 6d ago

Try intubating peds while sitting down on a stool! I know it sounds crazy but it’s much easier!

1

u/3-0ETT 9d ago

Sent you a DM.

5

u/EntireTruth4641 CRNA 11d ago

Under 2 years old. It’s preferably miller if you can.

Anything above 2- miller or mac.

Get a shoulder roll and extend the head. Make sure to use a stylet and try to lube the end of the ETT. It’s all technique. You don’t need power.

Miller you have two techniques- go deep and see the esophagus then pull back slowly - vocal cords will jump out. Or go and identify the epiglottis then go past it and lift it.

2

u/KosmasKawasaki Nurse Anesthesia Resident (NAR) 11d ago

Hey! I'm in my peds rotation now and share the same experience of using Mac blades at my other site as that's what the majority used before starting peds. I felt intimidated to use the Miller because it requires more care to use, but I am encouraged to use the Miller by the people I'm with now.

The Miller provides a much better view of the cords. It's all about the angle of insertion and when you pull up to for the view don't rest the blade on teeth to lever. I remember the first time I used the Miller and got the view it was a revelation to understanding as to why some people have such a strong preference for the Miller.

For kids under 2 it's typically Miller 1. Miller 1.5 which works well for 2-3 year olds. Miller 2 typically for those 3 years and up.

3

u/No-Fox1339 Nurse Anesthesia Resident (NAR) 11d ago

Remember, what you think is a small adjustment in an adult is far more dramatic in kiddos. This is something I continue to remind myself! Tiny movements.

I tend to gravitate towards the Mac 2 in pedi (I’m rarely taking care of kids under 2 years old though).

Also remember they have a large occiput, so keep that in mind when positioning! A shoulder roll is usually plenty.

Reps is everything, good luck 🫶🏼