Bent at ETI

Q: What is the purpose of the bent at the tip of the endotracheal tube introducer (ETI)?

Answer:  The endotracheal tube introducer (ETI), popularly known as bougie is frequently used during difficult intubation where vocal cords are not visible (Grade 3 view). The tip of the ETI is usually bent at the distal tip at a 30-degree angle. This purposefully applied bent servers two purposes. It allows an operator to direct the tip anteriorly under the epiglottis and through the vocal cords. Secondly, the bent helps an operator to feel and produce palpable "clicks" when advancing into the trachea. This is a pretty indicator of successful intubation.

Youtube video @ https://youtu.be/E7Lo1JD2Brk


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References:

1. Kidd JF, Dyson A, Latto IP. Successful difficult intubation. Use of the gum elastic bougie. Anaesthesia 1988; 43:437. 

2. Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA 2018; 319:2179.