SKILLS NCM 118
ETT
ENDOTRACHEAL TUBE- It is used if other artificial airways fail to maintain patent airway
-
Structure inserted to trachea
ARF- caused by wide range of etiology and it may result in cardiopulmonary arrest and worst
“death”
GOAL: Efficient and timing of airway management
Effective and Timely Airway Management
Artificial Airway- Devices that is inserted to assure airway patency
Types of Characteristics:
1. Non-toxic, Non-reactive, Adherent to tissue
2. Inexpensive
3. Firm but palpable
4. Durable
5. Easy to clean or sterile if not disposable
OPEN SUCTIONING- remove mech vent
CLOSED SUCTIONING- with vent
INTUBATION-process of inserting artificial airway to isolate trachea and prevent aspiration
Purposes of Intubation
1. Establish/maintain air
2. Administer Oxygen
3. Ventilate lung using resuscitation bag
4. Prevent upper airway obstruction
5. Aspiration of stomach content
6. Provide deep tracheal suctioning
7. Direct instill medications
TYPES:
1. Pharyngeal
a. Nasopharyngeal
b. Oropharyngeal
2. Tracheostomy
3. Endotracheal
APPARATUS SIZES
DIAMETER
FR
Infant
2.5-4.mm
6
6 months
3.5 mm
8
0-1yr
4-4.5mm
18 months
4 mm
8
3 yrs
4.5
8
5 yrs
5 mm
10
6 yrs
5.5 mm
10
8 yrs
6 mm
10
12
6 mm
10
16
7 mm
10
Adult
Female: 8-8.5 mm
12
Male: 8.5-9mm
14
Route:
1. Oral
a. fast and easy to insert/emergency airway
b. Ventilation during CPR
c. For short term mech vent/less than a need
d. Larger size ETT
e. Minimizing resistance
f. Easier suctioning
g. Reduce risk of the tube kinking
2. Nasal
a. For longer term intubation
b. Less salivation
c. For with oral/facial trauma/obstructions
d. Easier to stabilize
e. Maintained oral hygiene
f. Improve the ability to swallow secretions
g. Less gritting
h. Less posterior ulcer
i.
Less occlusion by biting/chiasmus
j.
Does not require muscle relaxants
Incidence of Pulmonary Infection
1. Bypass upper airway filtration
2. Increased aspiration of pharyngeal material
3. Contaminated equipment/solution
4. Impaired muco-salivary clearance in trachea
5. Increased mucosal damage due to suctioning/tube
6. Ineffective clearance via cuff
EQUIPMENTS
1. Laryngoscope-device to visualize trachea for insertion of airway tube
a. Straight Blade/Miller
b. Curved “Mc Intosh”- usually used
c. flow meter/tubing
d. Suction apparatus
e. Flexible sac catheter
f. Yankar
g. Manual resuscitation bag/mask
2. Prepare medication kit
a. Syringe: 1cc, 3cc, 5cc, 10cc
b. Diazepam
-
Prevent seizure
-
relaxant
c. Midazolam
-
sedative
d. Atropine
-
For salivation
e. Lidocaine
-
anesthesia
f. Fentanyl
-
pain
g. Salbutamol
3. Oxygenate the patient
a. using valve bag mask
b. attached the px pulse ox
4. E-cart is accessible/hear on within the room
5. Establish IV line
6. Anticipate medication
a. optional
b. ordered by the doctor
c. condition of px asking for it
d. 2-3 mins
7. Prepare Laryngoscope/blade
a. ensure battery and bulbs are working
b. ask what type of blade
8. Assist the dx during insertion
a. inflate the cuff
b. check the tube position in the level of midline
c. Fix the tube in place partially with tape
9. Continue to oxygenate the px
a. using bag valve
b. check pulse
10. Verify the position of the ETT immediately
a. auscultate
b. no sound
c. assess of both chest are rising
d. pressure of mist in the tube
e. disposable colorimetric
f. check xray
g. fiber laryngoscope
11. Sewing ETT in place
a. leukoplast
b. suction secretion
12. Attached the px to vent
a. check the dx order
b. check the mech vent
c. correspondingly the dx would order ABG
OROPHARYNGEAL
1. Laryngoscope with assorted blades
2. ETT (prepare 3 sizes)
3. Tongue depressor
4. Stylet or guide wire
5. Stethoscope
6. Tape
7. Syringe (10cc)
8. Lubricate Jelly
9. Magill forceps
10. Oral anesthetic
11. Towels
12. Barrier Precaution
a. Gloves
b. Gown
c. Mask
MANAGEMENT:
1. Aides oxygenation
2. Respiratory Status
3. Adequate humidity
4. Suction secretion
5. Assess oral mucosa
6. Secure ET w/tube or holder
7. Position px
8. Monitor cuff pressure (20-25mmHg)
9. Moving oral ETT per hour
10. Oral care
11. Use of bite lock
EXTUBATION:
a. check dx order