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Endotracheal Tube, Cuffed

Intubating Stylet

Many people are aware of the intubating stylet, however, they may not be aware of the malleable aluminum covered intubating stylet. This type of stylet is excellent for those who want to avoid the use of a metal tube. It is also more comfortable for the patient and can be reused.


Made of malleable aluminum covered with plastic sheath used for intubation assisatance.

Ref. No.: Size: Applicable ETT: Length (mm) Qty. Cs:
NMR103001 6 FR <3.5 302 400
NMR103003 10 FR 4.0-5.0 382 400
NMR103005 14 FR >5.5 382 400

What is an intubating stylet?

An intubating stylet is a medical device that is inserted into the trachea (windpipe) through the mouth in order to help place a breathing tube. The intubating stylet is malleable, meaning it can be bent into different shapes. It is also covered in aluminum, which helps it slide more easily through the trachea.

How to use an intubating stylet

If you need to intubate a patient, you'll need to use an intubating stylet. This guide will show you how to properly use the device.

First, assemble the intubating stylet. You'll need the malleable aluminum covered rod, the distal end cap, and the proximal end cap. Screw the end caps onto the rod, making sure that they are tight.

Next, lubricate the rod with a water-soluble jelly. This will help the rod slide into the patient's trachea more easily.

Now it's time to insert the stylet into the patient. Start by placing the tip of the rod at the entrance of the trachea. Then, gently insert the rod into the trachea until it reaches the vocal cords. At this point, you should be able to see the end of the rod poking through the vocal cords.

Finally, inflate the balloon at the end of the rod. This will help keep the tube in place once it is inserted. Now you can remove the stylet and insert a breathing tube into the patient's trachea.

The benefits of using an intubating stylet

An intubating stylet is a malleable aluminum covered rod that is used to facilitate the placement of an endotracheal tube. The use of an intubating stylet can help ensure proper placement of the endotracheal tube and minimize the risk of complications associated with intubation. Some of the potential benefits of using an intubating stylet include:

1. Reduced risk of esophageal intubation: One of the most serious complications associated with intubation is esophageal intubation, which occurs when the endotracheal tube is placed into the esophagus instead of the trachea. This can be very dangerous and even life-threatening. The use of an intubating stylet can help reduce the risk of esophageal intubation by ensuring that the endotracheal tube is properly positioned.

2. Reduced risk of airway trauma: Another complication associated with intubation is airway trauma. This can occur when the endotracheal tube is inserted too deeply into the trachea or if it is inserted at an angle that damages the airway tissues. The use of an intubating stylet can

The risks of using an intubating stylet

An intubating stylet is a malleable aluminum rod that is used to help place a breathing tube into a patient's airway. While it is a useful tool, there are some risks associated with using an intubating stylet.

One risk is that the aluminum rod can break, which can cause it to become lodged in the patient's airway. Another risk is that the rod can bend, which can make it difficult to remove from the patient's airway. Finally, if the rod is not placed correctly, it can cause the patient's airway to be blocked.

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Intubating Stylet Health Care Product

Intubating Stylet

Like many practices in medicine, MILS has never been studied in randomized controlled trials, Intubating Stylet, and the practice stems more from weak data and expert opinion. The practice of spinal stabilization began during the 1970s after a retrospective review published in 1979 of 300 patients with acute cervical injuries who presented to Johns Hopkins hospital between 1950 and 1972. Although the main focus was on the effects of laminectomy and steroids, the review also found that 11 of the 300 patients developed neurologic deficits after reaching the hospital. Of the 11 patients, 7 developed these deficits “after neck immobilization was not provided”, with no clear comment as to whether immobilization was not provided during intubation or during some other process of the patient’s care. These observations led to concerns that mobilization of the neck during intubation may worsen spinal cord injury, so manual in-line stabilization became the standard of care in the 1980s.

Existing data for spinal stabilization comes from trials of cadaveric models, case series, and uninjured patients. Data from cadavers with post-mortem surgically created cervical spine injuries have shown mixed results on the effects of the amount of measured movement at the injured site with versus without MILS. For example, a 1993 study by Donaldson et al. found higher degrees of subluxation and angulation at C5-C6 during orotracheal intubation without MILS compared to with stabilization in five cadaveric specimens with injuries created in that area. On the other hand, a 2001 Lennarson et al. study on cadavers found MILS significantly increased subluxation in C4-C5 during the same movements.  While it is somewhat counterintuitive that performing MILS might be associated with increased cervical motion, this may be explained by the laryngoscopist’s need to apply greater force with the laryngoscope in order to obtain an adequate view. This is what Santoni et al. (2009) found in a matched control study of 9 patients undergoing elective surgery. The patients in this study underwent two sequential laryngoscopies and oral intubations with a Macintosh 3 blade. Pressure transducers attached to the end of the blades detected higher maximum pressures at the best glottic view with MILS compared to without.

What is more clear in the literature on MILS than its effect on cervical motion is that it impairs glottic visualization and subsequent first-pass intubation success. In the aforementioned Donaldson study on cadavers, MILS was shown to have a negative impact on Cormack-Lehane (CL) grade. Similarly, in the aforementioned Santoni et al. study of 9 patients who underwent two sequential intubations with and without MILS, glottic visualization was worse in 6 patients with MILS, and intubation failure occurred in 2 of these 6 patients compared to no intubation failures among these patients when the intubation was performed without MILS. Thiboutot et al. (2008) performed a randomized controlled trial that further demonstrated this effect. In their study, 200 elective surgical patients were randomized to receive MILS or no MILS, and the primary endpoint was the rate of failed intubation at 30 seconds with a Mac 3 blade. The rate of failed intubation was half in the MILS group (50%, 47/94), significantly higher compared to the control group (5.7%, 6/105). When they released manual in-line stabilization, they were able to intubate all patients. Secondary outcomes of the rate of CL grade 3-4 as well as mean latency to successful intubation were also significantly higher in the MILS group. Additionally, these data were from patients undergoing elective surgery being intubated in the controlled OR setting by anesthesiologists. It is likely that the rate of failed intubation would be even higher in the chaotic emergency department environment with an acutely injured trauma patient. While 30 seconds is a somewhat arbitrary cutoff for a failed intubation, and it is quite possible many of the patients in the MILS group who “failed” may have been successfully intubated if a longer cut-off time were chosen, hypoxia caused by failed or delayed intubation is associated with poor outcome in central nervous system injury.


In an ideal world, a large-scale randomized controlled trial of trauma patients studying the effects of MILS on mortality and important functional neurologic outcomes would help elucidate the utility of this commonly accepted practice. However realistically, completing such a study has significant obstacles. Cervical spine injuries are relatively rare (4% of trauma injured patients)4 and only a small fraction of those cases involve unstable injuries with potentially salvageable cord function. Thus, a study with sufficient power to detect any meaningful difference in outcomes would take many thousands of patients, many trauma centers, and many years to complete. Perhaps an even larger hurdle is the ethical and medicolegal hurdle of randomizing patients to not getting MILS and possibly putting them at risk of quadriplegia. So what’s a clinician to do when faced with the common scenario of having to intubate a trauma patient? I personally like the approach that Dr. Reuben Strayer discusses in his video “Advanced Airway Management for the Emergency Physician” (link below). To summarize his strategy