Intubation: by Joan Singh

INTUBATION
By Joan Singh
INTUBATION
• Involves passing an endotracheal tube through the 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.
• There are different types of intubation classified
according to the location of the tube and what it’s trying
to accomplish.
PURPOSES OF INTUBATION
• To open up the airway to give oxygen, anesthesia, or medicine.
• To remove blockages.
• To help a person breathe if they have collapsed lungs, heart failure, or trauma.
• To allow doctors to examine the airways.
• To prevent aspiration.
INSTRUMENTS FOR INTUBATION
INTUBATION PROCEDURE
• https://www.youtube.com/watch?v=8AOB2PtHfVM&t=54s
• https://www.youtube.com/watch?v=FtJr7i7ENMY
COMMON TYPES OF INTUBATION
• Endotracheal intubation
• Nasogastric intubation
• Nasotracheal intubation
• Orotracheal intubation
• Fiber optic intubation
ENDOTRACHEAL INTUBATION
• Involves passing an endotracheal tube through the mouth or
nose into the trachea.
• It is usually passed with the aid of a laryngoscope by
specifically trained medical, nursing, or respiratory therapy
personnel.
• Once the tube is inserted, a cuff is inflated to prevent air
from leaking around the outer part of the tube, to minimize
the possibility of aspiration, and to prevent movement of
the tube.
• It 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.
NASOGASTRIC INTUBATION
• Involves passing the tube through the nose and into the stomach to remove air, or to feed or
provide medications to the patient.
NASOTRACHEAL INTUBATION
• the insertion of an endotracheal tube through the nose
and into the trachea without using a laryngoscope to
view the glottic opening.
• This technique may be used without hyperextension,
therefore it is useful when a client or patient has
cervical spinal trauma and with patients who have
clenched teeth.
• Blind intubation is only used if there are indications
that the larynx can not be visualized.
OROTRACHEAL INTUBATION
• the insertion of an endotracheal tube through the mouth
and into the trachea.
• This type is performed much more frequently than
nasotracheal intubation.
FIBER OPTIC INTUBATION
• A fiberoptic scope has an eyepiece to visualize the
larynx and a handle to control the tip. It is usually
2 1/2 - 3 feet long. It is inserted in the patient's
throat and guided to the larynx and glottic opening.
The endotracheal tube is then slid over the
fiberoptic scope into the trachea.
• This procedure is usually used when patient's are

unable to flex and extend their head for any reason.
• It is performed under sufficient local anesthesia
and conscious sedation is an appropriate technique
to prevent major hemodynamic changes during
intubation.
DISADVANTAGES
• Complications can occur from pressure exerted by the cuff on the tracheal wall. Cuff pressures
should be maintained between 15 and 20 mm Hg.
• High cuff pressure can cause tracheal bleeding, ischemia, and pressure necrosis, whereas low
cuff pressure can increase the risk of aspiration pneumonia.
• Routine deflation of the cuff is not recommended because of the increased risk of aspiration and
hypoxia.
• Tracheobronchial secretions are suctioned through the tube. Warmed, humidified oxygen should
always be introduced through the tube, whether the patient is breathing spontaneously or is
receiving ventilatory support.
• Endotracheal intubation may be used for no longer than 3 weeks, by which time a tracheostomy
must be considered to decrease irritation of and trauma to the tracheal lining, to reduce the
incidence of vocal cord paralysis (secondary to laryngeal nerve damage), and to decrease the
work of breathing.
DISADVANTAGES
• Endotracheal and tracheostomy tubes cause discomfort.
• The cough reflex is depressed because glottis closure is hindered.
• Secretions tend to become thicker because the warming and humidifying effect of the upper
respiratory tract has been bypassed.
• The swallowing reflexes (glottic, pharyngeal, and laryngeal reflexes) are depressed because
of prolonged disuse and the mechanical trauma produced by the endotracheal or
tracheostomy tube, increasing the risk of aspiration.
• Ulceration and stricture of the larynx or trachea may develop.
• Patient is unable to talk and communicate needs.
NURSING CARE OF THE PATIENT
WITH AN ENDOTRACHEAL TUBE
Immediately After Intubation
1. Check symmetry of chest expansion.
2. Auscultate breath sounds of anterior and lateral chest bilaterally.
3. Obtain order for chest x-ray to verify proper tube placement.
4. Check cuff pressure every 6-8 hours.
5. Monitor for signs and symptoms of aspiration.
6. Ensure high humidity; a visible mist should appear in the T-piece or ventilator tubing.
7. Administer oxygen concentration as prescribed by physician.
8. Secure the tube to the patient’s face with tape, and mark the proximal end for position maintenance.
a) Cut proximal end of tube if it is longer than 7.5cm (3 inches) to prevent kinking.
b) Insert an oral airway or mouth device to prevent the patient from biting and obstructing the tube.
NURSING CARE OF THE PATIENT
WITH AN ENDOTRACHEAL TUBE
Immediately After Intubation
9. Use sterile suction technique and airway care to prevent iatrogenic contamination and infection.
10. Continue to reposition patient every 2 hours and as needed to prevent atelectasis and to
optimize lung expansion.
11. Provide oral hygiene and suction the oropharynx when ever necessary.
- END -
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What are the main purposes of intubation?

What are some common types of intubation?

INTUBATION

• This procedure is usually used when patient's are

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