ENDOTRACHEAL

INTUBATION

Presented by-

Indrakshi Basu
st year, M.Sc. Nursing
1st

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
AcuteAirway
Pulmonary
Structural
Neuromuscular
Aspiration
Need
Respiratory
Anomaly
prophylaxis
Obstructive
Protection
Disorder
Failure
Disorder

CONTRAINDICATION
Cervical Spine Injury

MALLAMPATI
CLASSIFICATION

DIFFICULT

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

CURVE
D
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

neonates

Laryngeal mask for

difficult intubation

RESUSCITA
TION
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
Spinal cord injury

During intubation

CARDIOVASCULAR
COMPLICATIONS

TUBE RELATED
COMPLICATION
Advancement
Mechanical
damage
in bronchus
of upper airway structure
Dislodgement
kink & block

POST
INTUBATIONCOMPLICATI
ON
Laryngeal edema
Laryngospasm
Hemorrhage
Dysphonia

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