ET TUBE intubation

ET TUBE intubation and it's nursing management
especially useful for BNS students (Adult)as well as for medical students.: MBBS, Staff Nurse, BDS, Lab Technician etc...

1. 7/24/2022 Prepared by: RN Arpana Bhusal BNS

2. CONTENT LAYOUT Introduction ET intubation Indication Contraindication Methods of ET intubation Equipment for ET intubation Parts of ET tube 7/24/2022 3

3. CONTENT LAYOUT… Functions of ET tube Types of ET tube Nursing consideration for ET intubation Procedure of ET intubation Complications References 7/24/2022 4

4. The patient in the ICU often requires mechanical assistance to maintain airway patency. Inserting a tube into the trachea, bypassing upper airway and laryngeal structures, creates an artificial airway. The tube is placed into the trachea via the mouth or nose past the larynx (endotracheal [ET] intubation) or through a stoma in the neck (tracheostomy). ET intubation is more common in ICU patients. It can be performed quickly and safely at the bedside. 7/24/2022 5

5. Endotracheal intubation involves passing an endotracheal tube through mouth or nose into the trachea. Intubation provides a patent airway when the patient is having respiratory distress that cannot be treated with simpler methods. It is the method of choice in emergency care. Endotracheal intubation is a means of providing an airway for patients who cannot maintain an adequate airway on their own, for patients needing mechanical ventilation and for suctioning secretions from the pulmonary tree. 7/24/2022 6

6. Endotracheal tube 7/24/2022 7

7. Indications for ET intubation include : Upper airway obstruction (e.g. secondary to burn, tumor, bleeding) Apnea High risk of aspiration Ineffective clearance of secretions Respiratory distress Respiratory arrest. Cardiac arrest 7/24/2022 8

8. The following are only relative contraindications to tracheal intubation: Severe airway trauma or obstruction that does not permit safe passage of an endotracheal tube. Emergency cricothyrotomy is indicated in such cases. 7/24/2022 9

9. 7/24/2022 10 Cervical spine injury, in which the need for complete immobilization of the cervical spine makes endotracheal intubation difficult. Mallampati Classification of class III / IV or other determination of potential difficult airway.

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11. METHODS OF ET INTUBATION Nasal ET intubation Oral ET intubation Tracheal ET intubation( in case of tracheostomy) 7/24/2022 12

12. Endotracheal tube for proper size Average female size, 7.5-8.0 mm Average male si z e, 8.5-9.0 mm Stylet (metal wire) Larynscope and blade Straight blade (Miller) Curved blade (Macintosh) Suction 7/24/2022 13

13. CONTD… Tonsil tip ( Yankauer ) Suction kit Syringe to inflate balloon Topical anesthetic Lidocaine jelly or other agent Water soluble lubricant Tape or device to secure tube 7/24/2022 14

14. CONTD… Stethoscope Bag-valve device/ manual bag With reservoir Connected to oxygen at 15 L/min Optional equipment Magill forceps Oropharyngeal airway 7/24/2022 15

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16. An endotracheal tube : provides a passage for gases to flow between a patients lungs and an anaesthesia breathing system . allows one to provide positive pressure ventilation. protects the lung from contamination from gastric contents and nasopharyngeal matter such as blood. 7/24/2022 17

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21. Preformed endotracheal tubes 7/24/2022 22

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26. Laryngoscope and blade 7/24/2022 27

27. Oropharyngeal or nasopharyngeal airway 7/24/2022 28

28. Facemask and Magill's forceps 7/24/2022 29

29. NURSING CONSIDERATION FOR ET INTUBATION The intubation of the trachea is the responsibility of the doctor. However, the nurse helps him in the procedure by preparing the patient and keeping articles ready for use. Explain the purpose and procedure to the patient and visitors. Take consen t. Preparation of Articles: Endotracheal tubes of different sizes with an adaptor to connect to the ventilator or AMBU bag. S yringes to inflate the cuff. 7/24/2022 30

30. CONTD… Laryngoscope to visualize the larynx and to depress the tongue during the insertion. Flexible copper stylet – 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. 7/24/2022 31

31. CONTD… Oral airway to keep in the mouth of the patient after the intubation to prevent 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. 7/24/2022 32

32. CONTD… Oxygen supply. Suction apparatus. Anesthetics (if required) Remove the dentures, if any, to prevent dislodging and obstructing the airway. Never leave the patient alone. 7/24/2022 33

33. CONTD… Watch for complications such as laryngeal oedema, tracheal stenosis, haemorrhage etc. Watch and maintain an open airway. Remove secretions by effective suctioning. Prevent displacement of the tube. 7/24/2022 34

34. CONTD… Provide for the humidification of the air. Prevent infection introduced 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. 7/24/2022 35

35. CONTD… Maintain the oral hygiene of the patient. Carefully watch and record the vital signs. Apply suction if there is much secretions. Give oxygen if the patient is cyanosed. 7/24/2022 36

36. PROCEDURES OF ET INTUBATION The ET tube is passed through the mouth and vocal cords and into the trachea with the aid of a laryngoscope or bronchoscope. 7/24/2022 37

37. BEFORE THE PROCEDURE The patient is placed in a “sniffing” position to align the airway structures. Placing a folded towel or bath blanket under the head may help achieve this position. If the procedure is performed electively, a topical anesthetic and/or premedication with sedative or paralytic agent may be used so that the patient better tolerates the procedure. Before the procedure is performed, the patient is hyperoxygenated and hyperventilated with 100% oxygen by use of a bag-valve device with a face mask. 7/24/2022 38

38. CONTD.. The proper sized tube is chosen. All ETTs is increase the work of breathing; however a tube that is too small substantially increases the work of breathing and may make ventilation and weaning difficult. Choose the appropriate size of ET tube. After th e tub e i s se l ected , t h e cuf f on th e ball o o n is inflated to check for proper functioning and/or any leaks. 7/24/2022 39

39. CONTD.. A stylet is used to stiffen the ETT and facilitate insertion. The ETT is lubricated with a water-soluble lubricant. The laryngoscope is attached to the appropriate size and type of blade (straight or curved). The choice of blades varies. The straight blade elevates the epiglottis anteriorly to expose the vocal cords. 7/24/2022 40

40. CONTD.. The tip of the curved blade fits into the vallecula. When upward traction is placed on the laryngoscope, the epiglottis is displaced anteriorly. DURING THE PROCEDURE Hold the laryngoscope with left hand and irrespective of dominant hand. Open the mouth with right hand index finger with support of thumb. Introduce laryngoscope from right angle of mouth. 7/24/2022 41

41. CONTD.. Shift the tongue to the left and go in. Press over the tongue. See epiglottis and lift it. Watch for the vocal cord. Excess secretions and/or vomitus is suctioned to facilitate visualization of the vocal cords; the tonsil suction tip is very efficient in removing the secretion. The ETT is inserted 5 to 6 cm beyond the vocal cords, and the cuff is inflated. 7/24/2022 42

42. CONTD.. The procedure should be performed within 30 seconds. Co nnect the source to the tube. Confirm the position of the tube by:- Auscultation Chest expansion Bag movement Fix the tube with adhesive tape. 7/24/2022 43

43. CONTD.. Connection to ventilate with AMBU bag Anesthesia machine Ventilator AFTER THE PROCEDURE Place the patient in lateral position. Arrange for chest X-ray in order to check placement of ET Tube. 7/24/2022 44

44. CONTD.. Apply ET tube suctioning as needed. Watch for the chest movement, ET tube kinking, obstruction, leakage of tube cuff and over inflation of cuff. 7/24/2022 45

45. Several complications may occur as a result of oral endotracheal or nasotracheal intubation. Complications include : - trauma to airway structures hypoxia dysrhythmias aspiration accidental intubation of esophagus 7/24/2022 46

46. laryngospasm bronchospasm intubation of the right mainstem bronchus an endotracheal tube that is mistakenly sized or misplaced, especially in the apneic patient, can quickly lead to hypoxia and death Broken teeth or dentures 7/24/2022 47

47. ET EXTUBATION Assemble equipment. Intubation equipment In addition to intubation equipment, O2 devices and humidity, Suction ET tube Oxygenate patient Unsecure tube, deflate cuff. Ask patient to deep breathe and remove the ET tube. Apply appropriate O2 and humidity. Assess/reassess the patient condition. 7/24/2022 48

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49. REFERENCES 2019. Mayo Foundation of Medical Foundation and Research . ET intubation . https://www.mayoclinic.org@2021/06/25 at 2pm. October 23, 2018. Endotracheal tube intubation. https://www.slideshare.net@2021/06/25 at 2pm. https://www.canestar.com/ endotrachealintubationemergency -nursing- care..html @2021/07/5 at 1pm. 7/24/2022 50

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