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    Et Tube

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    inno so qt
    The document discusses endotracheal intubation, which involves inserting a tube into a patient's trachea to maintain an open airway. It is commonly used in ICU patients who are unable to maintain their own airway. The tube can be inserted through the mouth or nose and allows for mechanical ventilation and suctioning of secretions from the lungs. Precise placement of the tube is important to ensure proper ventilation and avoid complications.

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    Et Tube

    Uploaded by

    inno so qt
    90 views31 pages
    The document discusses endotracheal intubation, which involves inserting a tube into a patient's trachea to maintain an open airway. It is commonly used in ICU patients who are unable to maintain their own airway. The tube can be inserted through the mouth or nose and allows for mechanical ventilation and suctioning of secretions from the lungs. Precise placement of the tube is important to ensure proper ventilation and avoid complications.

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    ET_TUBE

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    The document discusses endotracheal intubation, which involves inserting a tube into a patient's trachea to maintain an open airway. It is commonly used in ICU patients who are unable to maintain their own airway. The tube can be inserted through the mouth or nose and allows for mechanical ventilation and suctioning of secretions from the lungs. Precise placement of the tube is important to ensure proper ventilation and avoid complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    90 views31 pages

    Et Tube

    Uploaded by

    inno so qt
    The document discusses endotracheal intubation, which involves inserting a tube into a patient's trachea to maintain an open airway. It is commonly used in ICU patients who are unable to maintain their own airway. The tube can be inserted through the mouth or nose and allows for mechanical ventilation and suctioning of secretions from the lungs. Precise placement of the tube is important to ensure proper ventilation and avoid complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 31

    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.
     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.
    Endotracheal tube
    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.
    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
    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.
     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.


     Endotracheal tube for proper size
     Average female size, 7.5-8.0 mm
     Average male sixe, 8.5-9.0 mm
     Stylet (metal wire)
     Larynscope and blade
     Straight blade (Miller)
     Curved blade (Macintosh)
     Suction
     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
     Stethoscope
     Bag-valve device/ manual bag
     With reservoir
     Connected to oxygen at 15 L/min
     Optional equipment
     Magill forceps
     Oropharyngeal airway
    Preformed endotracheal tubes
    The ET tube is passed through the mouth and
    vocal cords and into the trachea with the aid of
    a laryngoscope or bronchoscope.
     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.

     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.
     The average sized ETT used for females ranges from 7.5
    to 8.0 mm, whereas the average sized ETT used for
    males ranges from 8.5 to 9.0 mm.
     After the tube is selected, the cuff on the balloon
    is
    inflated to check for proper functioning and/or any leaks.

     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. The tip of the curved blade fits
    into the vallecula. When upward traction is placed on the
    laryngoscope, the epiglottis is displaced anteriorly.

     The person doing the intubation inserts the laryngoscope


    into the mouth to visualize the vocal cords.
     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.

     The procedure should be performed within 30


    seconds.

     If the intubation is difficult, the patient should be


    manually ventilated between intubation attempts.

     Frequently, the patient requires endotracheal


    suctioning for removal of excess secretions
    immediately after intubation.
     If the patient needs assistance with breathing, ventilation is
    achieved with either the bag-valve device or ventilator.

     Placement of the ETT is verified by the movement of air in


    and out of the tube, observation of bilateral chest expansion
    with inspiration and auscultation of bilateral breath sounds
    while the patient is ventilated with a bag-valve device.

     Another method for verifying tube placement is end-tidal


    carbon-dioxide monitoring. If th tube is in the trachea
    (versus esophagus), carbon dioxide is detected in exhaled
    air.

     After intubation a portable chest x-ray study is always


    performed for verification of the tube placement. The tip of
    the ETT should be approximately 2 to 5 cm above the carina.

     Once proper tube placement is verified, the ETT is secured


    with tape or another device in order to prevent dislodging.
    ADVANTAGES
     easily and quickly performed
     larger tube facilitates suction and procedures

    such as bronchoscopy
     less kinking of tube

    DISADVANTAGES
     not recommended in patients with suspended

    cervical injury
     uncomfortable
     mouth care more difficult to perform
     impairs ability to gag and swallow
     may increase salivation
     may cause irritation and ulceration of the

    mouth
    NASAL ENDOTRACHEAL INTUBATION
    The ET is placed blindingly (ie. Without visualizing the
    larynx) through the nose, nasopharynx and vocal cords.

    PROCEDURE FOR ORAL INTUBATION


     A nasotracheal ETT is usually better tolerated in an alert
    patient and may e easier to stabilize. In nasotracheal
    intubation, the ETT is usually inserted through the nares
    and then passed “blindly” into the glottis during
    inspiration.
     The blind intubation method is performed in the alert
    patient who is capable of spontaneous respirations.
     The nose and pharynx are anesthetized before the

    procedure.
     Nasotracheal intubation can also be performed through
    direct visualization. In this method, practitioners may
    use a laryngoscope and Magill forceps or fiberoptic
    bronchoscopy during the intubation.
    ADVANTAGES
     greater patient comfort and better tolerance
     better mouth care possible
     fewer oral complication
     less risk of accidental extubation
     facilitates swallowing of secretions
     can administer small amounts of oral liquids
    if patient able to swallow

    DISADVANTAGES
     more difficult to perform
     may cause nasal hemorrhage and sinusitis
     secretion removal more difficult because
    of smaller tube diameter and longer tube length
    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


     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
    Adequate ventilation is dependent on the free
    movement of air through the upper and lower
    airways. In many conditions, the airway becomes
    narrowed or blocked as a result of disease process,
    broncho-constriction, foreign body or secretions.

    Maintaining a patent (open) airway is achieved


    through meticulous airway management, whether
    in an emergency situation such as airway
    obstruction, or in long term management, as in
    caring for a patient with an endotracheal or a
    tracheostomy tube.

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