The bougie is a flexible device that is 60 cm in length and 15 French in diameter, with a small coude tip at the end (usually at a 35-40 degree angle).

This device is especially useful in Grade 3 or 4 Cormack Lehane airway views, edematous airways, blind digital intubations, and endotracheal tube exchanges. Here are a few tips to ensure success:

1. If operating alone, several methods can be used:
          - "Kiwi Grip": the ETT is preloaded onto the bougie and the proximal tip of the bougie is curled onto itself
          - "Pistol Grip": the bougie and ET tube are held together at the same time

2.Ideally, an assistant can place the ETT over the bougie once the bougie is passed through the vocal cords and maintain control fo the proximal portion of the bougie throughout the procedure

3. Insert the bougie via the side of the mouth, rather than down the midline, to provide better control of the coude tip in the vertical plane with rotation

4. Correct placement into the trachea is felt as “clicks” as the bougie slides over tracheal rings

5. The bougie should stop advancing at 30-40 cm (approximately half of the bougie) when the corina or bronchi are reached; if it continues to advance, it is likely to be in the esophagus and stomach

6. NEVER FORCE A BOUGIE; too much force can cause a perforation of the bronchi

7. If the ETT gets hung up while advancing through the cords, use a 90º anti-clockwise rotation to prevent its beveled point from getting caught in the arytenoids

8. There is a ~5% reported tracheal laceration rate, so beware using the bougie for routine intubations

       "Kiwi grip"

"Pistol Grip"