Today our topic of discussion is Endotracheal Intubations.
Endotracheal Intubations
Definition
Endotracheal intubation is assisting in passing of a slender hollow tube into trachea through nose or mouth to facilitate artificial ventilation and resuscitation, using aseptic technique (Fig. 29.9).
Purpose
- To treat acute respiratory failure, persistent hypoxemia, persistent rise in PCO,
- To maintain patent airway
- To ensure adequate oxygenation in fracture of cervical vertebrae, spinal cord injury
- To provide ventilatory assistance when indicated.
Objective: To insert an endotracheal tube into the trachea to provide a patent airway for ventilatory support or to manage secretions.
Assessment Phase
Does the client require intubations? Why are intubations being considered? Based on time considerations and on the condition of the client. Should nasal or oral intubations be attempted? Will the client need mechanical ventilation after intubations?
Precautions
Avoid damage to the client’s teeth and soft tissue, which can be caused by improper use of the laryngoscope and tubes or by unnecessary force during the procedure (Fig. 29.10)
Ensure the availability of an oxygen source.
Ventilate the client with a manual resuscitator using 100 percent oxygen if intubations cannot be accomplished within a reasonable period.Have suction equipment setup and operable at the client’s bedside before performing the procedure.
Avoid bronchial intubations by correctly positioning the endotracheal tube above the level of the carina (Fig. 29.9). Be alert for signs of esophageal intubations. These signs include abdominal distention, belching and lack of breath sounds in the lung fields after intubations.
Planning Phase (Figs. 29.11A and B)
- Endotracheal tubes with low pressure cuffs in various sizes (most common sizes for adult client range from 5 to 9 mm inside diameter).
- Laryngoscope handle and several sizes of both curved and straight blades.
- Topical anesthetic spray and sedative
- Water-soluble anesthetic lubricating jelly
- Flexible stylet
- Forceps 10 ml syringe
- Oral airway or bite block
- Tape, benzoin tincture and alcohol swabs
- Suction equipment
- Manual resuscitator with oxygen source.
Client/Family Teaching
- If the client is conscious, explain the need for endotracheal intubations and explain the procedure
- Explain sensations that may be experienced during the procedure
- Explain the need for endotracheal intubations and explain the procedure to the family.
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