What about endotracheal intubation
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In thus what is use of guarde wire
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Here is a complete answer on the use of the guidewire (bougie) in endotracheal intubation:
Guidewire / Gum Elastic Bougie in Endotracheal Intubation
The illustration from the textbook shows exactly what you're asking about:
FIG. 5 - Gum elastic bougie insertion with the endotracheal tube being advanced over it into the trachea.
What is it?
In intubation, the "guidewire" refers to the gum elastic bougie (also called a tracheal tube introducer). It is:
- A flexible, 60 cm long, 15 French introducer
- Has a Coude tip - angled at 40 degrees, 3.5 cm from the distal end
- Made of a semi-rigid woven material coated in resin
Why is it Used? (Main Purpose)
The bougie is used specifically in difficult airways - when direct laryngoscopy gives a poor view. This is classified using the Cormack-Lehane grading system:
| Grade | View | Action |
|---|---|---|
| 1-2 | Full or partial cords visible | Direct intubation possible |
| 3-4 | Only arytenoids/epiglottis seen, or nothing | Bougie needed |
When you can only see the arytenoids or epiglottis (but NOT the vocal cords), you cannot safely pass the ET tube directly - so the bougie goes in first.
Step-by-Step Technique
- Lubricate the bougie
- Insert with the Coude tip directed anteriorly (toward the trachea, not the esophagus)
- Advance until it reaches the level of the tracheal rings
- Confirm tracheal placement - you feel "clicks" or tracheal ring clicks (vibrations/reverberation) as the tip passes over the tracheal cartilage rings. If it goes into the esophagus, no clicks are felt
- Hold the bougie in place - then advance the endotracheal tube over the bougie (like a rail) through the vocal cords and into the trachea
- Remove the bougie once the ET tube is in position
- Confirm placement as usual - end-tidal CO2, bilateral breath sounds, chest rise
Key Clinical Points
- It acts like a rail or track that guides the ET tube into a trachea you cannot directly see
- The Coude angled tip helps it "hook" anteriorly into the trachea
- Tracheal ring clicks = correct position in trachea
- No clicks + tube advances >40 cm without resistance = esophageal placement (stop immediately)
- It is especially valuable in trauma patients where in-line cervical stabilization limits the laryngoscopic view
- Studies show bougie use gives a higher first-attempt success rate compared to a stylet alone, particularly for less experienced operators
As noted in Current Surgical Therapy 14e, the bougie is the go-to rescue device for Cormack-Lehane grade 3 or 4 views, and in Fischer's Mastery of Surgery, it is described as a key part of the difficult airway algorithm before escalating to supraglottic devices or a surgical airway.
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