Endotracheal Intubation/Extubation - PowerPoint PPT Presentation

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Endotracheal Intubation/Extubation

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Endotracheal Intubation/Extubation – PowerPoint PPT presentation

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Title: Endotracheal Intubation/Extubation


1
Endotracheal Intubation/Extubation
2
Upper Airway Anatomy (p. 158)
3
Visualization of Vocal Cords
4
Indications for Intubation
  • In conditions of, or leading to resp. failure,
    such as - trauma to the chest or airway -
    neurologic involvement from drugs myasthenia
    gravis, poisons, etc. -CV involvement leading to
    CNS impairment from strokes, tumors,
    infection, pulmonary emboli -CP arrest

5
Indications (contd)
  • Relief of airway obstruction
  • Protection of airway (I.e. seizures)
  • Evacuation of secretions by tracheal aspiration
  • Prevention of aspiration
  • Facilitation of positive press. ventilation

6
Relieving Airway Obstruction
  • Obstruction classified as upper ( above the
    glottis and includes the areas of the
    nasopharynx, oropharynx, and larynx) or lower
    (below the vocal cords)
  • Can also be classified as partial or complete
    obstruction
  • Causes include trauma, edema, tumors, changes in
    muscle tone or tissue support

7
Hazards of tracheal tubes cuffs
  • Infection
  • Trauma
  • Dehydration
  • Obstruction
  • Trauma

8
Hazards (contd)
  • Accidental intubation of the esophagus or right
    mainstem bronchus
  • Bronchospasm, laryngospasm
  • Cardiac arrhythmias resulting from stimulation of
    the vagus nerve
  • Aspiration pneumonia
  • Broken or loosened teeth

9
Later Complications of Intubation
  • Paralysis of the tongue
  • Ulcerations of the mouth
  • Paralysis of the vocal cords
  • Tissue stenosis and necrosis of the trachea

10
Routes for Intubation
  • Orotracheal
  • Nasotracheal
  • Tracheotomy

11
Oral Intubation
12
Advantages of Oral Intubation
  • Larger tube can be inserted
  • Tube can be inserted usually with more speed and
    ease with less trauma
  • Easier suctioning
  • Less airflow resistance
  • Reduced risk of tube kinking

13
Disadvantages of Oral Intubation
  • Gagging, coughing, salivation, and irritation can
    be induced with intact airway reflexes
  • Tube fixation is difficult, self-extubation
  • Gastric distention from frequent swallowing of
    air
  • Mucosal irritation and ulcerations of mouth
    (change tube position)

14
Nasal Intubation
15
Advantages of Nasal Intubation
  • More comfort long term
  • Decreased gagging
  • Less salivation, easier to swallow
  • Improved mouth care
  • Better tube fixation
  • Improved communication

16
Disadvantages of Nasal Intub.
  • Pain and discomfort
  • Nasal and paranasal complications, I.e.,
    epistaxis, sinusitis, otits
  • More difficult procedure
  • Smaller tube needed
  • Increased airflow resistance
  • Difficult suctioning
  • Bacteremia

17
Intubation Equipment
  • Endotracheal Tube and stylet
  • Laryngoscope
  • Sterile water-soluble jelly
  • Syringe to inflate cuff
  • Adhesive tape or tube fixation device
  • Bite block to prevent biting oral ET tube
  • Suction Equipment, bag- mask, O2
  • Local anesthetic
  • Stethoscope

18
Endotracheal Tube
19
Endotracheal Tube
  • ET tube size and depth of insertion (see p. 594)
  • For children older than 2 years - tube size
    age/4 4 - depth age/2 12
  • Adult - tube size female 8.0, male
    9.0 - depth female 19-21 and 24-26
    male 21-23 and 26-28

20
Stylet
21
Light stylet (light wand)
22
Laryngoscope
23
Laryngoscope
  • Blade and handle
  • Blade - has a flange, spatula, light, and
    tip - curved blade (Macintosh) - straight blade
    (Miller, Wisconsin)
  • Fiber optic vs. traditional laryngoscope
  • Blade size 0 - 1 infant, 2 from 2-8 years 3 from
    age 10 - adult, 4 large adult

24
Straight blade (Miller)
25
Curved blade (Macintosh)
26
Oral Intubation Procedure
  • Assemble and check equipment - suction
    equipment - laryngoscope - select proper
    size tube, check tube
  • Position patient - align mouth, pharynx,
    larynx - sniffing position

27
Patient Positioning
28
Oral Intubation Proced. (contd.)
  • Preoxygenate the patient - bag-valve
    mask - intubation attempt should take no
    longer than 30 sec, if unsuccessful, then
    ventilate again with bag and mask for 3-5
    minutes
  • Insert laryngoscope - hold laryngoscope in
    left hand insert in right side of mouth,
    displace tongue toward center

29
Oral procedure (contd.)
  • Visualize glottis and displace epiglottis

30
Oral proced. (contd.)
  • Insert ET tube - do not use laryngoscope
    blade to guide tube - once you see the
    tube pass the glottis, advance the cuff passed
    the cords by 2 -3 cm
  • Hold tube with right hand and remove
    laryngoscope stylet - inflate cuff with 5 -
    10 cc of air - ventilate with bag

31
Oral proced. (contd)
  • Inflate cuff with 5 - 10 cc of air
  • Ventilate with bag
  • Assess tube position - auscultation of chest
    epigastric - cm mark at teeth -
    capnometry/colorimetry - light wand
  • Stabilize tube/Confirm placement - chest x-ray

32
Extubation
  • Guidelines for extubation (see table, p. 613)
  • Cuff-leak test

33
Extubation Procedure
  • Assemble Equipment - intubation
    equipment - in addition to intubation
    equipment, O2 device and humidity, SVN with
    racemic epi
  • Suction ET tube
  • Oxygenate patient
  • Unsecure tube, deflate cuff

34
Extubation proced. (contd.)
  • Place suction catheter down tube and remove ET
    tube as you suction
  • Apply appropriate O2 and humidity
  • Assess/Reassess the patient
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