NOOTAN COLLEGE OF NURSING

SUBJECT : CHILD HEALTH NURSING

TOPIC : SEMINAR ON ENDOTRECHEA
INTUBATION

SUBMITTED TO SUBMITTED BY
Mrs, Mahalkshmi . B. Mrs, Sayma Mansuri
Associate professor 2 nd year m.sc nursing
NCN, visnagar Roll No: 03
NCN, Visnagar
BIO- DATA:

Name : Mrs. Sayma Mansuri

Subject : Child Health Nursing

Topic : Seminar on “ ENDOTRACHEAL

INTUBATION ”

Group of participants : 2nd Year M.Sc. Nursing Students

Date : 03 /04/2020

Time : 2:00 pm

Venue : Nootan College of Nursing,Visnagar

Method of teaching : Lecture cum discussion

A.V aids : Power point

Evaluator Name : Mrs, Mahalaxmi.B

GENERAL OBJECTIVES:

At the end of the seminar group will be able to gain in depth

knowledge about the endotracheal intubation will be efficiently practice in their field.

SPECIFIC OBJECTIVES:

At the end of the seminar group will be able to:

- Define endotracheal intubation .

- Describe the indication of endotracheal intubation.
- Explain the advantages and disadvantage of endotracheal intubation .
- List out the equipment of endotracheal intubation.
- Detail the contraindication of endotracheal intubation .
- Describe the complication of endotracheal intubation.
- Discuss the nursing responsibility of endotracheal intubation .
 ENDOTRACHEAL INTUBATION

DEFINITION – The insertion of a tube into the trachea to allow air to enter the lungs.

INDICATIONS:

Cardiopulmonary Arrest
Patient in deep coma or unresponsive
Shallow or slow respirations (less than 8 per minute)
Progressive cyanosis
Gastric lavage / gavage
Surgical patients where body positioning or facial contours preclude the use of a mask
To prevent loss of airway at a later time, i.e. a burn patient who inhales hot gases may be
incubated initially to prevent his airway from swelling shut

ADVANTAGES:

a. Provides an unobstructed airway when properly placed

b. Prevents aspiration of secretions (blood, mucous, stomach / bowel contents) into the
lungs
c. Can be easily maintained for a lengthy period of time
d. Decreases anatomic dead space by approximately 50%
e. Facilitates positive pressure breathing without gastric inflation
f. Facilitates body positioning and movement of the patient
g. May be utilized to pass medications like Narcan, Atropine, Epinephrine ,Lidocaine .

DISADVANTAGES:

o Need advanced training to properly perform procedure

o Bypasses the nares function of warming and filtering the air
o Increased incidence of trauma due to neck manipulation when spinal cord injury is
suspected
o May increase respiratory resistance
o Improper placement

REQUIRED EQUIPMENT:

1. Endotracheal tube

a. Size of tube is dependent on size of patient

b. 7.5 mm is the “Universally Accepted” size for an unknown victim
c. Men are usually larger, therefore an 8.0 mm tube may be appropriate
d. Females are usually smaller, therefore a 7.0 mm tube may be appropriate

2. 10 cc Syringe – used to fill the cuff at the end of the endotracheal tube

3. Stylet – a wire inserted into the endotracheal tube in order to stiffen it during passage
4. Water soluble lubrication – KY Jelly or Surgilube

5. Stethoscope – to check for proper placement of the endotracheal tube

6. Laryngoscope handle

7. Laryngoscope blade

8. Straight blade

9. Curved blade

10. Oropharyngeal airway (bite block) – to prevent the patient from biting down on the
endotracheal tube

11. Tape – to secure the endotracheal tube in place

12. Gloves

13. Ambu-bag – to facilitate positive pressure ventilations

14. Suction Device – to clear the airway of debris (blood, mucous, saliva)

FARMOLA FOR ENDOTRACHEAL TUBE INSERTION:

Predicted Size uncuffed tube = (age/4)+4

Predicted Size cuffed tube= (age/4) +3

Internal diameter of tube (mm) = (patient age in years/4) + 6

Depth of insertion (cm) =12+(patient age in years/2)

Patient preparation-

 Administer medication as ordered to decrease respiratory secretions, induce amnesia

analgesia and help calm and relax conscious patient.
 Remove dentures if present.
 Administer oxygen until tube is inserted to prevent hypoxia.
 Place patient supine in sniffing position so that his mouth, pharynx and trachea are
extended.
 Put on gloves.
 For oral intubation spray local anaesthetic deep into patient posterior pharynx to diminish
gag reflex and reduce patient’s discomfort.
 If necessary suction patient’s pharynx just before tube insertion
 Time each intubation attempt, limiting attempts to less than 30 seconds.
  Stand at head of patient’s bed. Using your right hand hold patient’s mouth open by
crossing your index finger, hold patient’s mouth open by crossing your index finger over
your thumb on patient’s upper teeth and your index finger on his lower teeth.
 Grasp the laryngoscope handle in your left hand and gently slide the blade into right side
of patient’s mouth.
 Center the blade and push the patient’s tongue to left. Hold patient’s lower lip away from
his teeth to prevent lip from being traumatized.
 Advance the blade to expose epiglottis.
 Lift laryngoscope handle upward and away from your body at a 45-degree angle to reveal
vocal cords.
 If desired, have an assistant apply pressure to cricoid cartilage to occlude esophagus and
minimize gastric regurgitation.
 When performing an oral intubation, insert ET tube into right side of patient’s mouth.
When performing a nasotracheal intubation, insert ET tube through nostril and into
pharynx.
 Guide tube into vertical openings of larynx between the vocal cords .If vocal cords are
closed because of spasm wait a few seconds them to relax and then gently guide tube past
them to avoid traumatic injury.
 Advance tube until cuff disappears beyond the vocal cords
 Holding the ET tube in place, quickly remove stillet if present.

Blind nasotracheal intubation

 Pass the ET tube along the floor of nasal cavity. If necessary use gentle force to pass tube
through nasopharynx and into the pharynx.
 Listen and feel for air movement through tube as it is advanced to ensure that tube is
properly placed in airway.
 Slip the tube between vocal cords when patient inhales
 Once the tube is past the vocal cords, the breath sounds become louder. If at any time
during advancement breath sounds disappear, withdraw the tube until they reappear.

After intubation-

 Inflate tube’s cuff with 5-10 cc of air until you feel resistance.
 Remove the laryngoscope.if patient was incubated orally, insert an oral airway to prevent
patient from obstructing airflow or puncturing tube with his teeth.
 To ensure correct tube placement observe for chest expansion and auscultate for bilateral
breath sounds feel tube’s tip for warm exhalations and listen for air movement.
 If you don’t hear any breath sounds, auscultate over stomach while ventilating with
resuscitation bag. If you don’t hear any breath sounds auscultate over stomach while
ventilating with resuscitation bag. Stomach distension, belching or gurgling sound
indicates esophageal intubation. Immediately deflate cuff and remove the tube.
 Auscultate bilaterally to exclude possibility of endotracheal intubation.
 Once you have confirmed correct tube placement administer oxygen or initiate
mechanical ventilation. And suction if indicated.
 To secure tube position applies benzoin tincture to each cheek and let it dry for enhanced
tape adhesion.
  Inflate the cuff with minimal leak technique or minimal occlusive volume technique.
 Clearly note centimetre marking on tube at
 position to avoid tube kinking.
 Auscultate both sides of chest and watch chest movement as indicated by patient
condition
 Give frequent oral care to orally point where tube exits patient’s mouth or nose.
 Make sure that chest X ray is taken to verify tube position.
 Place patient on his side with his head in a comfortable incubated patient position ET
tube
 Suction secretions through ET tube to clear secretions and prevent mucus plugs from
obstructing tube.

COMPLICATIONS-

 Apnea
 Aspiration of blood, secretions or gastric contents
 Bronchospasm
 Injury to lips, mouth, pharynx or vocal cords
 Laryngeal edema and erosion
 Tooth damage or loss
 Tracheal stenosis, erosion and necrosis

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

NURSING CONSIDERATIONS

 Maintain exact tube placement and tube must be well secured to avid kinking and prevent
bronchial obstruction and accidental extubation.
 Use the minimal leak technique to avoid tracheal erosion and necrosis.
 Always record volume of air needed to inflate cuff
- Gradual increase in volume indicates tracheal dilatation or erosion
- Sudden increase in volume indicates rupture of cuff and requires immediate
reintubation.
 Once the cuff has been inflated, measure its pressure at least every 8 hours to avoid over
inflation (normal cuff pressure is about 18 mmHg)
 Record date and time of procedure, its indications and success or failure. Tube type and
size, cuff size, amount of inflation, initation of supplemental oxygen or ventilator therapy
and results of chest x-ray
 Record any complications and nursing action taken.
 Note patient reaction to procedure
SUMMARY:

After the end of seminar our gain knowledge about endotracheal

intubation its definition, indications, contraindication, advantages, disadvantages ,
equipment, formula,complication and role of nurse during endotracheal intubation.

CONCLUSION:

Ventilator care is very important topic in clinical area and for

students to develop the knowledge about the endotracheal intubation and its also develop
the context of proper steps to follow the pediatrics patients .
BIBLIOGRAPHY

1. Marlow DR & Redding BA. Text Book of Pediatric Nursing. 6 th ed. New Delhi:
Elsevier India Private Limited; 2006.

2. Wilson D & Hockenberry MJ. Nursing Care of Infants and Children. 8th ed. New
Delhi: Elsevier Private Ltd; 2007.

3. Gupte S. The short Textbook of Pediatrics. 10th ed. New Delhi: Jaypee Brothers
Medical Publishers (P) Ltd; 2004.

4. Tortora, Graboski. Principles of Anatomy and Physiology. 10 th ed. New York: Sandra
Reynolds Publications; 2004.