- Document assent and complete appropriate consent form 1
- Arrange a time during daytime hours
- Gather information about the patient:
- Review recent blood results and drug chart 1
- Review recent chest imaging 1
- Determine the optimal depth of ETT and recent ventilatory requirements
- Stop enteral feed and ensure NG tube aspirated 1
- Consider ultrasound of the neck as part of risk assessment 1
- Ensure skilled assistants present and assign roles
- Prepare IV access, fluids and emergency drugs 1
- Ensure appropriate sedation and muscle relaxation 1:
- Consider the use of BIS to guide deep sedation
- Ensure full monitoring including EtCO2 (turned to face the operator) 1
- Set the ventilator 1:
- Pre-oxygenate with FiO2 of 1.0
- Mild hyperventilation often used with volume control ventilation
- Position the patient 1:
- Use a head ring
- Neck extended using pillow or bag of fluids under the shoulder blades
- Sitting up 30 degrees reduces venous distension and bleeding risk
