ENDOTRACHEAL INTUBATION

PURPOSE:
• Endotracheal intubation is performed to establish and maintain a patent airway, facilitate oxygenation and ventilation, reduce the risk of aspiration, and assist with the clearance of secretions.

NOTE:
• This procedure should be performed only by physicians, advanced practice nurses, and other health care professionals (including critical care nurses) with additional knowledge, skills and demonstrated competence per professional licensure or institutional standard.

PREREQUISITE NURSING KNOWLEDGE
INDICATIONS: •
• • • Upper airway obstruction (e.g., secondary to swelling, trauma, tumor, bleeding) Apnea Ineffective clearance of secretions (e.g. Inability to adequate maintain airway) High risk of aspiration Respiratory distress

WHAT TO DO:
• Pulse oximetry should be used during intubation so that oxygen desaturation can be quickly detected. Pre-oxygenation with 100% oxygen using a bag-valve-mask device with a tight-fitting face mask should be performed for 3 to 5 minutes before intubation. Intubation attempts should take no longer than 15 to 30 seconds. Applying cricoid pressure (Sellick maneuver) may decrease the incidence of pulmonary aspiration and gastric distention. This procedure is accomplished by applying firm, downward pressure on the cricoid ring, pushing the vocal cords downward so they are more easily visualized. Once begun, cricoid pressure must be maintained until intubation is completed.


• •

EQUIPMENT:


• • • • • • • • • • • • • •

Personal protective equipment Endotracheal tube with intact cuff and 15 mm connector ( Adult female 7.5 to 8.0 mm tube, adult male 8.0 to 9.0-mm tube) Laryngoscope handle with fresh batteries Laryngoscope blades (straight or curved) Spare bulb for laryngoscope blades Flexible stylet Self-inflating resuscitation bag with mask connected to 100% oxygen Oxygen source and connecting tubes Non-sterile gloves Luer-tip 10 ml syringe for cuff inflation Water-soluble lubricant Rigid pharyngeal suction-tip catheter Suction apparatus Suction catheter ET Tube tape (adhesive ( 6 to 8 in long) Stethoscope

• • •

Sedating or paralyzing medications Forceps to remove foreign bodies Local anesthesia

PARTS OF A LARYNGOSCOPE

PARTS OF AN ENDOTRACHEAL TUBE

ENDOTRACHEAL INTUBATION

CHEST TUBE/THORACOSTOMY
INDICATIONS: • • • • Drainage of hemothorax, or large pleural effusion of any cause Drainage of large pneumothorax (greater than 25%) Prophylactic placement of chest tubes in a patient with suspected chest trauma before transport to specialized trauma center Flail chest segment requiring ventilator support, severe pulmonary contusion with effusion

MATERIALS • • • • • • • Chest tube with or without trocar or catheter Chest tube suction unit tubing, suction machine Chest tube tray to include scalpel blade and handle, large Kelly clamps, needle driver, scissors Packet of 0 or 1.0 silk suture on a curved needle Tape, gauze 2% lidocaine with epinephrine, 20 cc syringe, 23-gauge needle for infiltration Sterile prep solution; mask, gown and gloves

CHEST TUBE INSERTION

Step 1: Incising the chest wall

Step 2: Opening the incision with a Kelly clamp

Step 3: Using a Kelly clamp to guide insertion of chest tube

Step 4: Inserting a chest tube

Size of Chest Tube

Adult or Teen Male Adult or Teen Female Child Newborn

28-32 Fr 28 Fr

18 Fr 12-14 Fr

NASOGASTRIC INTUBATION
• A nasogastric (na-so-gas-tric) tube is a thin soft tube that is passed through the nostril, down the back of the throat and into the stomach.

Reason for insertion of NG
• An NG is normally put in so that specially prepared liquid food can be put down the tube to feed the client. The reason may include: If the client (pedriatric clients) has problems with their sucking and swallowing if your client is not getting enough nutrition through their normal diet If client cannot swallow medications they need Sometimes, an NGT may be put in to empty the stomach contents through the tube.  For gastric lavage    

EQUIPMENTS
• All necessary equipment should be prepared, assembled and available at the bedside prior to starting the NG tube. Basic equipment includes:  Personal protective equipment  NG/OG tube  Catheter tip irrigation 60ml syringe  Water-soluble lubricant, preferably 2% Xylocaine jelly  Adhesive tape  Low powered suction device OR Drainage bag

   

Stethoscope Cup of water (if necessary)/ ice chips Emesis basin pH indicator strips

STEPS

NASOGASTRIC TUBE

LEVIN TUBE

Size Colour Code

FG-8 Blue

FG-10 FG-12 FG-14 Black White Green

FG-16 Orange

FG-18 Red

FG-20 Yellow

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