INTUBATION

REFLECTION

Intubation is the insertion of a flexible plastic tube into the trachea to

maintain an open airway or to provide a conduit for the administration of
medications. I Intubation is used when a patient cannot keep their airway
open, can't breathe without help, or both. They may be undergoing surgery and
will be unable to breathe on their own, or they may be too sick or damaged to
provide adequate oxygen to the body without help. Respiratory failure (hypoxic
or hypercapnic), apnea, a low level of consciousness (sometimes stated as GCS
less than or equal to 8), rapid change of mental status, airway injury or
impending airway compromise, high risk of aspiration, or "trauma to the box"
are all indications for intubation.

This procedure is very helpful to people nowadays as covid-19 strikes, it

may extend a person’s life by giving the support oxygen to breath when they
cannot breathe on their own. Aside from that, it gives hopeless people a chance
to be alive even with their current situations, such as patients in the ICU, and
with this, it can help a person to be better. I am happy that I will be able to
learn this procedure because in today’s situation, having knowledge about this
procedure is important.

To conclude, this innovative equipment are means to extend life of a

person who are suffering due to lack of oxygen.
 TWO FUNCTIONING IV
 OXYGEN
 MONITOR [CARDIAC (DEFIB PADS, PULSE OXIMETER)]
 PRE-OXYGENATION (5-8 MINS), FILL UP LUNGS AS HIGH AS
POSSIBLE. (HIGH FLOW NASAL CANNULA AND NON-REBREATHER
MASK, TAKE 8 TO 10 DEEP SLOW VITAL CAPACITY BREATH IF
CONSCIOUS.)
EQUIPMENT:
 SUCTION (CONNECTED TO SUCTION CANNISTER)
 LARYNGEAL SCOPE
 ET TUBE (6.5, 7.0-7.5- STANDARD ADULT)
 RIGID STYLET- GIVE ET TUBE TO GIVE FORM
 FLUSH 10 CC SYRINGE TO RELEASE AIR TO THE ET TUBE
 BAG VALVE MASK ATTACHED TO ET TUBE TO INFLATE THE LUNGS
 CO2 DEVICE- YELLOW TO PURPLE (C02 EXHALED FROM THE LUNGS)
CONFIRMS YOU ARE IN THE AIRWAY NOT ESOPHAGUS
 FORCEPS- HELPFUL WHEN SOMETHING BLOCKS THE AIRWAY
PROCEDURE:
 POSITION CLIENT (SHOULD BE AT THE HEAD OF THE BED).
 SNIFFING POSITION (FLEXION OF THE HEAD AND ELEVATION OF THE
OCCIPUT)- STRAIGHTENING OUT THE AIRWAY ANGLE. FOLLOW C
SPINE PRECAUTIONS. PUT TOWEL OR PILLOW TO THE OCCIPUT TO
ELEVATE AND BRINGS OUT THE JAW.
 PUSH THE MEDICATION (SEDATIVE FOLLOWED BY PARALYTICS)
TAKES 30-2 MINUTES.
 MOVE THE JAW AND NOTES FOR LAXITY TO DETERMINE THEY ARE
PARALYZED.
 LOOK AT THE VOCAL CORDS BY REMOVING THE OXYGEN MASK
LEAVING THE NASAL CANNULA ONLY.
 WITH THE LARYNGOSCOPE (HOLD WITH NON-DOMINANT HAND) DO A
LIFTING MOTION (IN AND LIFT)
 PULL THE CHEEKS (GOOD VISUALIZATION) PLACE BLADE TO THE
RIGHT SIDE OF THE MOUTH SWEEPING THE TONGUE TO THE LEFT
SIDE OF THE MOUTH TO BRING THE BLADE MIDLINE.
 LIFT THE LARYNGOSCOPE 90 DEGREE ANGLE.
 LOOK FOR THE EPIGLOTTIS. TUCK BLADE FORWARD TO POP UP THE
EPIGLOTTIS TO VIEW THE VOCAL CORDS.
  IF YOURE HAVING HARD TIME SEEING THE VOCAL CORD, DO
EXTERNAL LARYNGEAL MANIPULATION WHILE PUSHING ON THE
THYROID TO BRING THE VOCAL CORDS INTO VIEW.
 HAVE ASSISTANCE BY HANDING YOU THE ET TUBE AND INSERT
THROUGH THE VOCAL CORDS 3-4 CM BEYOND THE VOCAL CORDS.
 HOLD ET TUBE AGAINST THE TEETH.
 ASSISTANT NURSE WILL INFLATE THE BALLOON. AND PUT CO2
DETECTOR TO CONFIRM THE ET TUBE IS IN THE AIRWAY. (YELLOW
TO PURPLE).
 NURSE LISTENS TO THE BILATERAL LUNGS IN THE AXILA OR IN
EPIGASRTUM TO CONFIRM BREATH SOUNDS.
 SECURE THE TUBE.
 POST INTUBATION XRAY
 POST INTUBATION MEDICATION (SEDATION AND PAIN CONTROL)- TO
AVOID THE CLIENT PULLING THE TUBE OUT.

Nursing Responsibilities:
Before
 Aseptic (sterile) procedure
 Position patient for comfort depending on site to be inserted
 Use local anesthetic; patient may feel pressure as tube is inserted
During
 Ensure the ET for placement. Note lip line marking and compare it
with the desired placement (18cm, 20cm, and 22cm).
 Closely monitor cuff pressure, maintaining a pressure of 20 to 25
mmHg to minimize the risk of tracheal necrosis.
 Use a bite block to avoid patient from biting down.
After
 Ensure that the required oxygen support indicated for the patient
is provided.
 Assess the client’s respiratory status at least every 2 hours or
frequently as indicated. Note the lung sounds and presence of
secretions.
 Ensure that adequate humidity is provided to avoid feeling of
dryness in the oropharynx.
 Suction secretions orally to prevent aspiration. This also decreases
the risk for infection.
 Assess nasal and oral mucosa for redness and irritation.
 Secure the endotracheal tube with tape or ET holder to prevent
movement or deviation of the tube in the trachea.
 Place the patient in a side-lying position or semi fowler’s if not
contraindicated to avoid aspiration. Reposition patient every 2
hours. This will allow the lungs to expand better and prevent
secretions stagnation.
 Communicate frequently with the client. Give patient means to
communicate using a whiteboard or communication board.