Removal of stylet during intubation

Q: What's the best time to remove the stylet from the Endotracheal Tube (ETT) while intubating the patient? - select one

A) Once the tip of the ETT has passed the vocal cords

B) After the ETT is fully inserted inside the trachea

Answer: A

An inexperienced operator usually keeps the stylet in the ETT till the tube is fully inserted and set in the trachea. This approach may cause injury or obstruct the passage of the tube beyond the vocal cords. 

Ideally, once the tip of the ETT has passed the vocal cords, the operator should pause and ask the staff next to remove the stylet while maintaining a firm hold on the tube and a clear view of the ETT and the glottis.

#procedures

References/further reading:

1. Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook TM; Difficult Airway Society; Intensive Care Society; Faculty of Intensive Care Medicine; Royal College of Anaesthetists. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018 Feb;120(2):323-352. doi: 10.1016/j.bja.2017.10.021. Epub 2017 Nov 26. PMID: 29406182.

2. DeMasi SC, Casey JD, Semler MW. Evidence-based Emergency Tracheal Intubation. Am J Respir Crit Care Med. 2025 Jul;211(7):1156-1164. doi: 10.1164/rccm.202411-2165CI. PMID: 40238943; PMCID: PMC12264701.

3. Long B, Gottlieb M. Emergency medicine updates: Endotracheal intubation. Am J Emerg Med. 2024 Nov;85:108-116. doi: 10.1016/j.ajem.2024.08.042. Epub 2024 Sep 3. PMID: 39255682.