ENDOTRACHEAL INTUBATION

Presented by-

Indrakshi Basu

1st year, M.Sc. Nursing

INTRODUCTION

An emergent critical care procedure.

Needs advanced nursing Practice.

Ensure AIRWAY Patency.

Done by physicians, assisted by nursing personnel.

RELATED ANATOMY AND PHYSIOLOGY

ENDOTRACHEAL TUBE PLACEMENT

DEFINITION

• Insertion of a hollow, slender, long tube into trachea bypassing the upper airway and laryngeal strictures to create an alternative airway solution.

• Distal tip of tube situates just above carina.

INDICATION

Acute Respiratory

Failure

Pulmonary Obstructive

Disorder

Trauma & Injury

Structural Anomaly

Neuromuscular Disorder

Aspiration prophylaxis

Post-operative

Anaphylaxis

Need Airway Protection

CONTRAINDICATION

•Airway Trauma

•Cervical Spine Injury

•Mallampati classification (iii / iv)

MALLAMPATI CLASSIFICATION

DIFFICULT INTUBATION

DESCRIPTION

No anticipated difficulty• GRADE 1: Visualised soft palate,

fauces, uvuala, tonsillar pillar.

• GRADE 2: Visualised soft palate,

fauces,uvuala.

Anticipated difficulty• GRADE 3(Moderate): Visualised soft palate, base

of uvuala.• GRADE 4(Severe): No soft palate visualised.

TYPES

• 1. orotracheal intubation.• 2. Nasotracheal intubation.

TECHNIQUES

CURVED BLADE

TECHNIQUE

STRAIGHT BLADE

SIZE of E. T. TUBE

Distance between lips and location in mid trachea of distal end (in cm)is the size of ET tube.

Premature: 2.5 mm Full term: 3.0 mm Adult (male): 8 to 8.5 mm Adult (female): 7.5mm

Internal diameter

ARTICLE PREPARATION Tray set up. Uninterrupted source of oxygen. Medication.

MEDICATIONS

KETAMINE 1.5 -2 mg/kg. TBW. ETOMEDITE 0.3-0.4 mg/kg TBW. MIDAZOLAM 0.1- 0.3 mg/kg TBW. PROPOFOL 1-2.5 mg/kg TBW + (0.4* TBW). FENTANYL 2-10 mcg/kg TBW.

Uncuffed E.T. tube for neonatesLaryngeal mask for difficult intubation

RESUSCITATION TROLLY

GENERAL CONSIDERATION

Privacy and comfort. Safety. Consent. Assembling resources tactfully. Asepsis. Communication aid of client.

PROCEDURE

• J:\New folder\Endotracheal intubation A3chem Multimedia.mp4

AFTER CARE OF CLIENT

Tidy up . X- ray report collection. Documentation. DOPE-Displacement of tube, tube obstruction

Pneumothorax, equipment failure. Suction. Cuff Pressure measurement. Reporting as vulnerable client. VAP Bundle. * *

AFTER CARE OF ARTICLE

Ambu bag in Closed zip bag.

Papers

Plastic items

Body waste

COMPLICATIONS

During intubation

Spinal cord injury

Aspiration

Dental damage

Laceraton & perforation

Tube goes

cranial vault

Epistaxis

Delayed resuscitation

Corneal abrasion

Cartilage dislocatio

n

CARDIOVASCULAR COMPLICATIONS

* PSVT• VT• BRADYR

HYTHMIA

HYPERTENSIONHYPOTENSION

TUBE RELATED COMPLICATION

kink & block Dislodgement

Advancement in bronchus

Mechanical damage of upper airway

structure

POST INTUBATIONCOMPLICATION

Laryngospasm Laryngeal edema

Dysphonia Hemorrhage

Principles in the procedure?

• SPECIFIC PRINCIPLES: Microbiology, Anatomy & Physiology, Body

mechanics, Psychology, Pharmacology, skilled practice hand, Radiology…..

• GENERAL PRINCIPLES OF NURSING: Safety, therapeutic effectiveness, economy of

resources….

Any quiry????

Thank you