Endotracheal Intubation

Endotracheal Intubation

When it comes to emergency and life threatening situations, there are only three letters to be remembered. ABC’s. Nope, not the simple ABC we learned in preschool. It actually stands for airway, breathing and circulation, with airway as the top priority. Securing the airway in emergency situations is very crucial when you want to save a life and in cases where life-threatening injuries and illnesses need to be managed.

ET Intubation: What it is, and what it is for

Endotracheal intubation is a procedure wherein a flexible plastic tube is inserted through the mouth down into the trachea, which serves as the large airway from the mouth to the lungs. Usually, when performing this procedure, 3 members of the healthcare team are present: An experienced anesthetist, an experienced nurse and a nurse new to critical care. During surgeries, the patient is sedated before the intubation, while in emergency situations the patient is usually unconscious when performing the procedure.

An ET tube, which serves as an open passage through the upper airway, allows air to pass freely to and from the lungs in order to ventilate the lungs. It can be connected to ventilator machines to provide artificial ventilation. With the ET tube present, you may be able to suction secretions from the trachea. It also helps critically ill patients who are unable to maintain adequate respiratory function to meet their needs

The Procedure

The procedure must be done with informed consent. Before the intubation, the patient is pre-oxygenated first so as to maximize the patient’s partial pressure of oxygen. A hand-held facial mask over the nose and mouth may also be done. The secretions must also be suctioned to facilitate better visualization f the vocal chords and to clear the airway.

With the help of a laryngoscope, which aids the doctor in visualizing the upper portion of the trachea just below the vocal cords and in holding the tongue, the tube is inserted through the mouth down to the trachea. During this procedure, the head must be positioned appropriately so as to allow proper visualization. The thyroid cartilage of better known as the Adam’s apple is applied with pressure for the purpose of helping with visualization and preventing possible aspiration of stomach contents.

According to the Advanced Life Support Manual the suggested usual size of the ET tube which is required for male ET intubation is 8-9cm and for women 7-8cm. It should be positioned at about 23cm at the incisors for men and 21cm for women, and positioned about 2cm above the carina. This may be seen when conducting a Chest X-ray after the intubation.

Once the tube is inserted, the cuff should be inflated and secured as well as checked for pressure with a manometer. Equal expansion of the chest must be observed and auscultation should be done at the mid-axillary line. The patient may be attached to the VR and Chest-Xrays and Arterial Blood Gas tests must be done.

In critical situations when a life may be at stake. It is important that the nurse knows what to do, what to prepare, what they are doing and their role in the situation. By doing so, panic can be avoided and patient safety is ensured.

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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