Endotracheal tube Intubation..nursesoutlook

INTRODUCTION-:

Very often, the nurses working in the causality services may have to help the doctors in endotracheal intubation in order to save the life of the patient.

Endotracheal intubation are artificial airways inserted to relieve mechanical airway obstruction, provide a route for mechanical ventilation, permit easy access for secretion removal, and protect the airway from gross aspiration in clients with impaired cough or gag reflexs.

Endotracheal intubation is a procedure performed by a physician or specially trained health personnel.

Endotracheal tube intubation 

DEFINITION-:

Endotracheal tube Intubation is assisting in passing of a hollows tube into trachea through nose or mouth using aseptic techniques to facilitate artificial ventilation and resuscitation. It passes through the vocal cords and its distal tip sits just above the Carina.



PURPOSES-:

• To treat acute respiratory failure, persistent hypoxemia, persistent rise in PCO2.


• To maintain patient airway


• To ensure adequate oxygenation in fracture cervical vertebrae, spinal cord injury.


• To provide ventilatory assistance when indicated.


• To remove secretions


• To administer anaesthetics ( in the operation theater).

OBJECTIVES-:

• To insert an endotracheal tube into trachea to provide a patient airway for ventilatory support or to manage secretions.

INDICATION-:

• CNS depression


• Neuromuscular disease


• Chest wall injury


• Upper airway obstruction

Anticipated upper airway obstruction ( edema, soft tissue swelling due to head and

Neck trauma) postoperative head and neck surgeries.

• Aspiration prophylaxis


• Fracture of cervical, vertebral and spinal cord injury.

ENDOTRACHEAL TUBE-:

A wide variety of endotracheal tube in use for orotracheal or naso- tracheal intubation. They are available with cuffs and without cuffs. Orotracheal tubes are larger than the naso- tracheal tubes. As in the case of tracheostomy tubes, the endotracheal tube have no inner tubes which can be removed for cleaning. The size of each tube is marked in mm on the outer side of each tube.

Approximate size of the endotracheal tubes for different age groups are as follows-:

• New born infants               -  5mm   to  4mm


• 0 to 1 years                           -    4mm to 4.5mm


• Children up to 10 years   - 5mm to 7mm


• Children                              -    7mm to 8mm


• Adults                                   - 8mm to 9.5 mm

PREPARATION OF THE ARTICLES/ARTICLES NEEDED FOR ET INTUBATION-:

• Endotracheal tube of different sizes with an adaptor to connect to the ventilator or ambu


• Syringes to inflate the


• Laryngoscope to visualize the larynx and to depress the tongue during the insertion.


• Flexible copper style-to be used as a guide during the insertion and to give the tube greater rigidity.


• Extra syringes and needles for medication.


• Lubricant to lubricate the tube.


• Ambu bag to ventilate the lungs.


• Oral airway to keep in the mouth of the patient after the patient biting on to and occluding an endotracheal tube.


• Gauze wipes, to clean the secretions.


• Gloves to maintain asepsis.

Adhesive plaster-to fix the endotracheal tube in place.

• Magill,s intubating forceps to direct endotracheal tube into the trachea.


• Oxygen supply


• Suction apparatus.


• Anaesthetics ( if required)

PROCEDURE-:

• Explain procedure to the patient if conscious and get consent from patient and relatives.


• Place patient in supine position with head extended by keeping sand bag or towel roll under neck.


• Check for loose teeth/dentures, if so remove with magill’s forceps.


• Seal mouth and nose with mask and ambo bag and initiate bagging with oxygen.


• Provide laryngoscope to doctor.


• Suction oral cavity


• Provide lubricated endotracheal tube with stiletto in situ.


• Press crico- thyroid cartilage with thumb and index finger against esophagus.

Assist while endotrachealtube is introduced into trachea and remove stiletto. The tube when inserted should have the 22cm marking at the incisor teeth and tube should be fixed

At the midline to prevent pressure ulcer at the angle of the mouth.

• Verify placement of tube by auscultation, listening or feeling for airflow through tube and observe for bilateral chest movements.


• Connect ambo bag with oxygen attached to endotracheal tube and continue.


• Inflate cuff of the endotracheal tube with 10ml of air.


• Insert an oral airway and apply endotracheal suctioning if necessary.


• Fix endotracheal tube in position by using adhesive tape.


• Connect to ventilator if needed.

Post procedural care

• Place patient in lateral position


• Arrange for chest X- ray to be taken in order to check placement of ET tube.


• Apply endotracheal suctioning if secretions present.


• Watch for chest movement, ET tube kinking, obstruction with secretions and blood, leakage of tube cuff, change in position of the tube and over inflammation of cuff.

Document type and size of tube used, chest movements, vital signs and patient’s tolerance To procedure.

• Check ABG periodically.

After care of the patient:

• Never leave the patient alone


• Watch and maintain an open airway


• Remove secretions by effective suctioning


• Prevent displacement of the tube.


• Watch for complications such as laryngeal oedema, tracheal stenosis, haemorrhage  etc..


• Provide for the humidification of the air by boiling a kettle of water in the patient’s unit


• Prevent infection introduction into the lungs.


• Prevent contamination of the inhaled air.


• Maintain adequate nutrition of the patient by naso- gastric feeding or by giving intravenous fluids. They should never be fed on oral feeds as long as the tube is in the mouth.


• Maintain the oral hygiene of the signs.


• Carefully watch and record the vital signs.


• Apply suction if there is much secretions.


• Give oxygen if the patient is cyanosed.

Keep an emergency tracheotomy tray with tracheotomy tubes of correct size at the bedside of the patient for emergency use.



ADVANTAGES OF THE ENDOTRACHEAL TUBE INTUBATION-:

• The intubation can be done rapidly and an incision on the throat can be avoided. It is less time consuming and the results are predictable.


• Good for the short term intubation.


• Easy to insert


• Shorter length


• Minimal gastric distension.


• DISADVANTAGES OF THE ENDOTRACHEAL TUBE INTUBATION-:

• Suctioning through the endotracheal tube is less effective and it is more traumatic because it can cause extensive and permanent damage to the larynx and the vocal cord.


• In case of severe burns and laryngeal edema, the endotracheal tubeis less practical.