ENDOTRACHEAL INTUBATION

Definition: It is a procedure of passing of an endotracheal tube into trachea through the nose or mouth.

Purpose: It 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.

Indications:  In neonatal asphyxia: Bag & mask ventilation fails to improve cardiac status or heart rate fails below 80/ min  Infants with diaphragmatic hernia  Thick meconium stained babies.  Babies requiring prolonged positive pressure ventilation.  Apparently still born baby after adequate suctioning of upper airways  As a pre-requisite for artificial ventilation  Cardio- respiratory arrest  CNS depression  Diseases of peripheral nervous system  Administration of general anesthesia  Upper airway obstruction  Apnea  Ineffective clearance of secretions  High risk of aspiration  Respiratory distress

mucous. Epinephrine d.Contraindications:  Obstruction of the upper airway due to foreign objects  Cervical fractures  The following conditions require caution before attempting to intubate:  Esophageal disease  Ingestion of caustic substances  Mandibular fractures  Laryngeal edema  Thermal or chemical burns Advantages:  Provides an unobstructed airway when properly placed  Prevents aspiration of secretions (blood. stomach / bowel contents) into the lungs  Can be easily maintained for a lengthy period of time  Decreases anatomic dead space by approximately 50%  Facilitates positive pressure breathing without gastric inflation  Facilitates body positioning and movement of the patient  May be utilized to pass medications a. Narcan b. Atropine c. Lidocaine Disadvantages:  Need advanced training to properly perform procedure  Bypasses the nares function of warming and filtering the air  Increased incidence of trauma due to neck manipulation when spinal cord injury is suspected  May increase respiratory resistance  Improper placement Equipment:  Personal protective equipment  Endotracheal tube with intact cuff and 15 mm connector  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 .

and the upper teeth must not be used as a fulcrum 14) Visualize the vocal cords 15) Using the right hand. To correct this problem.      Suction catheter ET Tube adhesive tape (6 to 8 in long) Stethoscope Sedating or paralyzing medications Forceps to remove foreign bodies Local anesthesia Procedure: 1) Maintain the patient¶s ABC¶s 2) Determine that the patient requires endotracheal intubation 3) Assemble required equipment 4) Position the patient¶s head ± three axes. and the trachea must be aligned to achieve direct visualization of the vocal cords 5) Sniffing Position ± the head is extended and the neck is flexed 6) A folded towel may be placed under the patients shoulders and neck to assist with positioning 7) Suction the patient (no longer than 30 seconds) 8) Oxygenate patient for 1 minute with 100% Oxygen 9) Insert the laryngoscope blade and place endotracheal tube 10) Laryngoscope handle is held with the left hand 11) Insert the laryngoscope blade in the patients right side of the mouth and sweep to the center of the mouth 12) Lift the laryngoscope blade in an upward motion 13) The handle must not be used with a prying motion. Advance the tube an additional ½ to 1 inch for proper placement. 16) Remove the laryngoscope carefully from the patients mouth 17) Remove the stylet from the endotracheal tube 18) Ventilate the patient with two breaths 19) Check for proper placement with these first two ventilation¶s by: 20) Observing the chest rise and fall with each ventilation: 21) Proper placement will cause both lungs to inflate with each ventilation 22) Auscultating for bilateral breath sounds:  Breath sounds will be completely absent if placed within the esophagus. This prevents air from going into the left lung. Remove the endotracheal tube and attempt placement after 1 minute of oxygenation and ventilation.  If the tube is placed too far down the tracheal tree. the pharynx. insert the endotracheal tube until you see the cuff pass through the vocal cords. continue to ventilate patient and slowly withdraw endotracheal tube ¼ . those of the mouth. a right main stem intubation can occur.½ inch or until bilateral breath sounds are heard. .

 Auscultating over epigastrium for gastric sounds:  Placement of the endotracheal tube into the stomach / esophagus will produce gurgling sounds in the epigastric area. and the patient¶s posterior pharyngeal area 7) Deflate the endotracheal tube¶s cuff 8) Withdraw the endotracheal tube with one smooth motion 9) Monitor the patient for signs / symptoms of respiratory distress or difficulty . Remove the endotracheal tube and attempt placement after 1 minute of oxygenation and ventilation. the patient¶s mouth. 23) Inflate the endotracheal tube¶s cuff with 10 cc¶s of air: 24) Inflation of the balloon serves two purposes: 25) Holds tube in place 26) Acts as a barrier and prevents fluids from entering the lungs 27) Ventilate the patient with two breaths 28) Insert oropharyngeal airway 29) Ventilate the patient with two breaths 30) Tape endotracheal tube securely in place 31) Continue to ventilate patient (1 breath every 5 seconds) and suction as necessary Removing Procedure: 1) Determine that endotracheal intubation is no longer required 2) Patient begins spontaneous respiration¶s 3) Medical Officer orders removal of endotracheal tube 4) Remove tape from endotracheal tube 5) Remove oropharyngeal airway from patient¶s mouth 6) Suction the endotracheal tube.

JMJ Marist Brothers Notre Dame of Dadiangas University College of Nursing S. Tuban. 2010-2011 2ND Semester WARD CLASS: ENDOTRACHEAL INTUBATION In partial fulfillment of the requirements in RLE Submitted to: Reca Rose E. SN BSN 3A January 2010 .Y. RN Clinical Instructor Submitted by: Kate Penelope Dalid.

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