ENDOTRACHEAL TUBE INTUBATION

DEFINITION: - Assisting in passing of a slender hollow tube into trachea through nose or mouth
using aseptic technique to facilitate artificial ventilation and resuscitation.

PURPOSES: -There is some purposes given below

 To treat respiratory failure, persistent hypoxemia and persistent rise in pCO2.
 To maintain patent airway.
 To ensure adequate oxygenation.
 To provide ventilator assistance when indicated.
INDICATIONS: - There is some indications
 CNS depression
 Neuromuscular diseases
 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, and decreased level of consciousness).
 Aspiration prophylaxis
 Fracture of cervical vertebrae and spinal cord injury.
COMPLICATIONS: - There are some complications
 Laryngeal/ tracheal injury
 Pulmonary infection and sepsis
 Dependence on artificial airway
ARTICLES:-
 Sandbag/ towel roll
 Suction apparatus with tubing
 Suction catheter (Fr 14)
 Ambu bag and mask
 Oxygen source and tubing
 Laryngoscope with appropriate size blade
 Magill’s forceps
 Endotracheal tubes of appropriate size
 Stilette
 Xylocaine gel
 Disposable syringe 10 ml
 Oral airway
  Cotton tape/Dynaplast
 Sterile gloves
 Facemask
PROCEDURE FOR ENDOTRACHEAL TUBE INTUBATION:-
S. NURSING ACTION RATIONAL
NO.
1. Explain procedure to the patient if conscious and Promote acceptance of procedure and
get consent from patient and relatives. cooperation for procedure from patient.
2. Place patient in supine position with head Promote access to trachea.
extended by keeping sandbag or towel roll under
neck.
3. Check for loose teeth/ dentures of foreign body in Avoids danger of loose teeth or foreign body
throat if so remove with Magill’s forceps. causing airway obstruction in unconscious
patients.
4. Seal mouth and nose with mask and AMBU bag
and initiate bagging with oxygen.
5. Provide laryngoscope to doctor.
6. Suction oral cavity. Provides a clear field of work and prevents
aspiration when performing oral trachea
insertion.
7. Provide lubricated endotracheal tube with stiletto Facilitates insertion without chances of injury.
in situ.
8. Press crio-thyroid cartilage with thumb and index Permits clear visualization of oropharynx for
finger against esophagus. insertion.
9. Assist while endotracheal tube is introduced into
trachea and remove stilette. The tube when
inserted should have the 22 cm marking at the
incisor teeth.
10. Venty placement of tube by auscultation, Confirms tube placement.
listening/feeling for airflow through tube and
observe for bilateral chest movements.
11. Connect Ambubag with oxygen attached to
endotracheal tube and continue bagging.
12. Inflate cuff of the endotracheal tube with 10 ml of Prevents chances of the displacement and
air. aspiration.
13. Insert an oral airway and apply endotracheal
 suctioning.
14. Endotracheal tube in position by using adhesive
tape. Tube should be fixed at the midline to
prevent pressure ulcer at the angle of mouth.
15. Connect to ventilator if needed.

POSTPROCEDURAL 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 are present.
 Watch for chest movements, ET tube kinking, obstruction with secretion and blood, leakage of
tube cuff, change in position of tube and over inflation of cuff.
 Document type and size of tube used, chest movements, vital signs and patient’s tolerances of
procedures.
 Check ABGs periodically.
SPECIAL CONSIDERATIONS:-
Check cuff pressure using manometer (if available) for detecting under inflation or over inflation of cuff.
Inflated, it can lead to aspiration and displacement of tube. Over inflation can lead to tracheal injury and
ulcerate leading to stenosis.
 BIBLIOGRAPHY

BOOK REFERENCES:-
 SHEBEER. P. BASHEER, “A Concise, “Text Book Of Advance Nursing Practice” First Edition
2012, EMMESS Medical Publishers Bangalore, Page No.273 - 287.

 BRAR NAVDEEP KAUR RAWAT HC, “Text Book Of Advance Nursing Practice”, first Edition
2012, Jaypee Brothers New Delhi page no. 474 - 496

 BRUNNER AND SUDDARTH‘ , Textbook Of Medical Surgical Nursing, Edition 13th ,Published
By Lippincott Publishers, Printed In 2009, Pp 410- 423.

 JOYEE M BLACK AND HAWKS J.H., “A Text book of Medical Surgical Nursing”, Clinical
Management For Positive Outcomes, Edition 7th , Printed In 2009.page no. 452-462