Tube over the bougie...."I can not deliver the tube"

The bougie works.

Most studies report 10-15% increase in first pass success rates.

It’s cheap and the technique is easy to learn

There is however one big problem with the bougie, a problem it shares with other tube-over-guide techniques – the arythenoid hang-up.The space between the bougie and the tube tip becomes a ‘hook’ that snags the arythenoid.And the result will be "I can not deliver the tube" and in worst-case-scenario the whole intubation attempt is abandoned .

The fix of this common problem is in the following Image...

In this image

Retract the tube a centimetre or so.

Then turn the tube counter-clockwise 90 degrees so that the tip and the ‘hook’ is anterior and clear of the arythenoids.

Then pass the tube between the vocal cords.

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