1 Endotracheal Intubation/Extubati on. 2 Upper Airway Anatomy (p. 158)
Post on 20-Jan-2016
221 Views
Preview:
Transcript
1
Endotracheal Intubation/Extubation
2
Upper Airway Anatomy (p. 158)
3
Visualization of Vocal Cords
4
Indications for Intubation
In conditions of, or leading to resp. failure, such as; - trauma to the chest or airway - neurologic involvement from drugs myasthenia gravis, poisons, etc. -CV involvement leading to CNS impairment from strokes, tumors, infection, pulmonary emboli -CP arrest
5
Indications (cont’d)
Relief of airway obstruction Protection of airway (I.e. seizures) Evacuation of secretions by tracheal
aspiration Prevention of aspiration Facilitation of positive press. ventilation
6
Relieving Airway Obstruction
Obstruction classified as upper ( above the glottis and includes the areas of the nasopharynx, oropharynx, and larynx) or lower (below the vocal cords)
Can also be classified as partial or complete obstruction
Causes include trauma, edema, tumors, changes in muscle tone or tissue support
7
Hazards of tracheal tubes & cuffs Infection Trauma Dehydration Obstruction Trauma
8
Hazards (cont’d)
Accidental intubation of the esophagus or right mainstem bronchus
Bronchospasm, laryngospasm Cardiac arrhythmias resulting from
stimulation of the vagus nerve Aspiration pneumonia Broken or loosened teeth
9
Later Complications of Intubation Paralysis of the tongue Ulcerations of the mouth Paralysis of the vocal cords Tissue stenosis and necrosis of the trachea
10
Routes for Intubation
Orotracheal Nasotracheal Tracheotomy
11
Oral Intubation
12
Advantages of Oral Intubation Larger tube can be inserted Tube can be inserted usually with more
speed and ease with less trauma Easier suctioning Less airflow resistance Reduced risk of tube kinking
13
Disadvantages of Oral Intubation Gagging, coughing, salivation, and irritation
can be induced with intact airway reflexes Tube fixation is difficult, self-extubation Gastric distention from frequent swallowing
of air Mucosal irritation and ulcerations of mouth
(change tube position)
14
Nasal Intubation
15
Advantages of Nasal Intubation More comfort long term Decreased gagging Less salivation, easier to swallow Improved mouth care Better tube fixation Improved communication
16
Disadvantages of Nasal Intub. Pain and discomfort Nasal and paranasal complications, I.e.,
epistaxis, sinusitis, otits More difficult procedure Smaller tube needed Increased airflow resistance Difficult suctioning Bacteremia
17
Intubation Equipment
Endotracheal Tube and stylet Laryngoscope Sterile water-soluble jelly Syringe to inflate cuff Adhesive tape or tube fixation device Bite block to prevent biting oral ET tube Suction Equipment, bag- mask, O2 Local anesthetic Stethoscope
18
Endotracheal Tube
19
Endotracheal Tube
ET tube size and depth of insertion (see p. 594)
For children older than 2 years - tube size = age/4 + 4 - depth = age/2 + 12
Adult - tube size female = 8.0, male = 9.0 - depth female = 19-21 and 24-26 male = 21-23 and 26-28
20
Stylet
21
Light stylet (light wand)
22
Laryngoscope
23
Laryngoscope
Blade and handle Blade
- has a flange, spatula, light, and tip - curved blade (Macintosh) - straight blade (Miller, Wisconsin)
Fiber optic vs. traditional laryngoscope Blade size: 0 - 1 infant, 2 from 2-8 years 3
from age 10 - adult, 4 large adult
24
Straight blade (Miller)
25
Curved blade (Macintosh)
26
Oral Intubation Procedure
Assemble and check equipment - suction equipment - laryngoscope - select proper size tube, check tube
Position patient - align mouth, pharynx, larynx - “sniffing” position
27
Patient Positioning
28
Oral Intubation Proced. (cont’d.) Preoxygenate the patient -
bag-valve mask - *intubation attempt should take no longer than 30 sec, if unsuccessful, then ventilate again with bag and mask for 3-5 minutes
Insert laryngoscope - hold laryngoscope in left hand & insert in right side of mouth, displace tongue toward center
29
Oral procedure (cont’d.)
Visualize glottis and displace epiglottis
30
Oral proced. (cont’d.)
Insert ET tube - do not use laryngoscope blade to guide tube - once you see the tube pass the glottis, advance the cuff passed the cords by 2 -3 cm
Hold tube with right hand and remove laryngoscope & stylet - inflate cuff with 5 - 10 cc of air - ventilate with bag
31
Oral proced. (cont’d)
Inflate cuff with 5 - 10 cc of air Ventilate with “bag” Assess tube position -
auscultation of chest & epigastric - cm mark at teeth - capnometry/colorimetry - light “wand”
Stabilize tube/Confirm placement- chest x-ray
32
Extubation
Guidelines for extubation (see table, p. 613) Cuff-leak test
33
Extubation Procedure
Assemble Equipment - intubation equipment - in addition to intubation equipment, O2 device and humidity, SVN with racemic epi
Suction ET tube Oxygenate patient Unsecure tube, deflate cuff
34
Extubation proced. (cont’d.)
Place suction catheter down tube and remove ET tube as you suction
Apply appropriate O2 and humidity Assess/Reassess the patient
top related