PRE INTUBATION

GROUP MEMBERS PBEN 0133

AHMAD IKLIL HAKIM BIN MUSTAFA
KASTHURI AP MURALEEDHARAN
KOMALAVANI THULASY
MOHAMAD FITRI BIN SAMSURI
MOHAMMAD IZZAT BIN DUL BAHRI
RANJINI A/P NADARAJAH
PREMA MANIAM
 OBJECTIVE
DEFINE ENDOTRACHEAL INTUBATION

CONTRADICATION OF PRE INTUBATION

LIST EQUIPMENT AND PREPARATION OF PATIENT

NURSING RESPONSIBILITIES IN PRE INTUBATION

 DEFINITION
Pre-intubation refers to the period of time immediately preceding the insertion
of an endotracheal tube (intubation) into a patient's airway.
This phase typically involves preparatory measures such as assessing the
patient's airway, administering sedation or anaesthesia if necessary, positioning
the patient appropriately, and gathering the necessary equipment for
intubation.
 Pre-intubation procedures are crucial for ensuring the safety and success of
the intubation process, particularly in critically ill or injured patients.
 INDICATION
Respiratory Failure
Respiratory Arrest
Airway Protection(risk of aspiration)
Inability to Protect Airway(trauma)
Altered Mental Status (LOC)
Surgery or Procedures Requiring Intubation
Ventilatory Support
Cardiopulmonary Resuscitation (CPR)
Inability to Maintain Patent Airway
Pulmonary Contusion
 CONTRADICTION
Patient Refusal
Unstable Cervical Spine
Facial Trauma or Injury
Active Gag Reflex
Bleeding Disorders
Cardiorespiratory instability during intubation attempts
PREPARATION PATIENT FOR
PRE INTUBATION
 EQUIPMENT PREPARATION

Ensure all necessary equipment for intubation is readily available and functioning properly. This typically
includes:
Endotracheal tubes (ETTs) of appropriate size.
Laryngoscope with blades appropriate for the patient's anatomy.
Suction apparatus and suction catheters.
Bag-valve-mask device for ventilation.
Stylet (if needed) to shape the ETT.
 CONT….
Syringes for medication administration.
Lubricating jelly.
Tape or securing device for securing the ETT.
Capnography device for confirming correct ETT placement.
Monitoring equipment for vital signs and oxygen saturation.
Backup airway devices (e.g., supraglottic airway devices) in case of intubation failure.
 CONT….
Medication Selection and Draw-Up:
Select appropriate induction agents (e.g., etomidate, propofol, ketamine) and neuromuscular
blocking agents (e.g., succinylcholine, rocuronium) based on the patient's clinical condition,
comorbidities, and allergies.
Draw up medications in labelled syringes with appropriate doses.
Have reversal agents (if applicable) readily available.
Team Briefing and Communication:
Brief the intubation team on the patient's clinical status, anticipated difficulties, and the planned
approach for intubation.
Establish clear communication channels and roles within the team (e.g., airway operator, assistant,
medication administrator).
 CONT….
Backup Plans:
Anticipate potential complications or difficult airway scenarios and have backup
plans in place (e.g., alternative intubation techniques, rescue airway devices,
surgical airway equipment).
Consider the need for awake intubation or rapid sequence intubation based on
the patient's condition and airway assessment.
Informed Consent:
Obtain informed consent from the patient or their surrogate if possible, explaining
the risks, benefits, and alternatives to intubation.
EQUIPMENT
 NURSING RESPONSIBILITIES PRE
INTUBATION
Explain procedure
Ensure standard precautions
Prepare and check all equipment
Prepare patient in a supine position
Maintain patient warmth
Ensure continuous monitoring - Monitors (ECG cable with leads, spo2 probe, NIBP, temperature
probe. Etco2 probe
Ensure suction equipment functioning
Remove the dentures, if any, to prevent dislodging and obstructing airway
 CONT…
Patient Assessment:
Conduct a thorough assessment of the patient's airway, breathing, and circulation.
Assess the patient's baseline vital signs, oxygen saturation, and level of consciousness.
Identify any factors that may complicate intubation, such as anatomical abnormalities, trauma, or
medical history.
Communication and Collaboration:
Communicate effectively with the healthcare team, including physicians, respiratory therapists,
and other nurses, to coordinate the timing and logistics of intubation.
Ensure that the patient and their family members understand the need for intubation, the
procedure itself, and any potential risks or complications.
 Patient Positioning:
Assist in positioning the patient properly for intubation, ensuring optimal alignment
of the airway axes and stability of the cervical spine if indicated.
Provide support and reassurance to the patient to alleviate anxiety and discomfort.
Medication Administration:
Assist with medication administration as directed by the physician, including induction agents and
neuromuscular blocking agents.
Prepare medications, draw up doses, and label syringes according to institutional protocols.
Documentation:
Document baseline vital signs, oxygen saturation, and relevant patient information in the medical
record.
Record the timing and dosages of medications administered during the pre-intubation period.
Emotional Support:
Provide emotional support and reassurance to the patient and their family members before
intubation.
Address any concerns or questions the patient may have about the procedure and its implications.
Safety Measures:
Ensure that the patient's safety is maintained throughout the pre-intubation process, including
proper positioning, monitoring, and infection control practices.
Verify patient identification and confirm correct procedure and patient consent before proceeding
with intubation.
REFERENCES
Alvarado, A. C. (2023, July 10). Endotracheal tube intubation techniques. StatPearls
[Internet]. https://www.ncbi.nlm.nih.gov/books/NBK560730/
V. (2019, April 28). Intubation ppt. SlideShare.
https://www.slideshare.net/vijayvandali/intubation-ppt
Russotto V, Myatra SN, Laffey JG. What’s new in airway management of the
critically ill. Intensive Care Med. 2019;45(11):1615-1618. doi:10.1007/s00134-019-
05757-0
Russotto V, Cortegiani A, Raineri SM, Gregoretti C, Giarratano A. Respiratory
support techniques to avoid desaturation in critically ill patients requiring
endotracheal intubation: a systematic review and meta-analysis. J Crit Care.
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Anaesth. 2020;125(1):e18-e21. doi:10.1016/j.bja.2020.04.008
CONT…
Mosier JM. Physiologically difficult airway in critically ill patients: winning the race
between haemoglobin desaturation and tracheal intubation. Br J Anaesth.
2020;125(1):e1-e4. doi:10.1016/j.bja.2019.12.001
Mosier JM, Sakles JC, Law JA, Brown CA III, Brindley PG. Tracheal intubation in the
critically ill. where we came from and where we should go. Am J Respir Crit Care
Med. 2020;201(7):775-788. doi:10.1164/rccm.201908-1636CI
Mosier JM, Hypes CD, Sakles JC. Understanding preoxygenation and apneic
oxygenation during intubation in the critically ill. Intensive Care Med.
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THANK YOU