endotracheal intubation ncm 106

Endotracheal Intubationand

Cardiocentesis

is the placement of a tube into the trachea (windpipe) in order to maintain an open airway in patients who are unconscious or unable to breathe on their own. Oxygen, anesthetics, or other gaseous medications can be delivered through the tube.

Airway protection

To treat profound hypoxaemia and respiratory failure and to initiate positive pressure ventilation

To facilitate tracheal suction and the removal of secretions

To maintain respiratory function during surgery/anaesthetics

respiratory arrest respiratory failure airway obstruction need for prolonged ventilatory support multiple trauma, head injury and abnormal

mental status inhalation injury with erythema/edema of

the vocal cords

Indication:

Laryngoscopes,

Self-refilling bag valve combination

A selection of endotracheal tubes

Oral airways

Gloves

A rigid oral suctioning catheter

EQUIPMENT

Stethoscope

Checked and working ventilator

Resuscitation equipment immediately available in case of complications

Lubrication, Magill forceps, introducer

10ml syringe

tape

The nurse should tell the patient what is about to happen, and they should then be pre-oxygenated.

PREPARING THE PATIENT

The doctor often inserts the tube with the help of a laryngoscope, . During the procedure the laryngoscope is used to hold the tongue aside while inserting the tube into the trachea. It is important that the head be positioned in the appropriate manner to allow for proper visualization. Pressure is often applied to the thyroid cartilage (Adam's apple)to help with visualization and prevent possible aspiration of stomach contents

Intubation Procedure.3gp

PROCEDURE

NURSING RESPONSIBILITIES

Gather all the materials needed

Check the light of the laryngoscope

The patient's position flat with their face at the level of the xiphoid cartilage of the standing person performing the procedure

Compresses the cricoid cartilage against the cervical vertebrae

do open gloving or wear personal protective equipment

BEFORE

nurse should calmly describe the vital-signs status of the patient regularly

Be prepared to pass the ET tube and other equipment to the person intubating or physician

If necessary, suction patient’s pharynx

observed for equal expansion and auscultation performed at the mid-axillary line

Administer sedatives, per doctors order

DURING

 The tube should be secured

patient attached to an appropriate ventilator and a check X-ray ordered

arterial blood gases should be taken

auscultate both sides of the chest

suction secretions via the Endotracheal Tub

AFTER

Trauma to lips, teeth, vocal chords

Transient cardiac arrhythmia related to vagal or sympathetic nerve traffic

Hypertension, tachycardia or raised intracranial pressure

Aspiration.

Infection

POST-INTUBATION COMPLICATIONS

Tracheal ulceration

Tracheal stenosis

Hypersalivation

Laryngeal oedema

Bronchospasm

Reduced ability to communicate

Biting on tube

Discomfort

Tube kinked or damaged on insertion, resulting in perforation and leaks

CARDIOCENTESIS

 is a medical procedure that involves the removal of fluid from the pericardial sac.

Pericardial effusion

INDICATION

chest X-rays, blood tests, electrocardiogram, echocardiograms

anti-inflammatory medicines and blood thinners

PREPARATION

the patient is required to take a supine position

the doctor is guided with the use of an ultrasound or electrocardiographic device.

After the needle is positioned correctly, the doctor replaces it with a catheter.

a cardiocentesis procedure lasts for two minutes to one hour, if the method runs without complications.

PROCEDURE

Close care

Monitor for pericardial output

POST OP CARE

Bleeding

lung collapse

heart attack or irregular heartbeat

severe perforation

Pneumopericardium

Pericardiocentesis.3gp

COMPLICATION