ENDOTRACHEAL INTUBATION

PURPOSE:Endotracheal intubation is performed to establish and maintain a patent airway, facilitate oxygenation and ventilation, reduce the risk of aspiration, and assist with the clearance of secretions.

NOTE:This procedure should be performed only by physicians, advanced practice nurses, and other health care professionals (including critical care nurses) with additional knowledge, skills and demonstrated competence per professional licensure or institutional standard.

PREREQUISITE NURSING KNOWLEDGE

INDICATIONS:

Upper airway obstruction (e.g., secondary to swelling, trauma, tumor, bleeding)ApneaIneffective clearance of secretions (e.g. Inability to adequate maintain airway)High risk of aspirationRespiratory distress

WHAT TO DO:

Pulse oximetry should be used during intubation so that oxygen desaturation can be quickly detected.Pre-oxygenation with 100% oxygen using a bag-valve-mask device with a tight-fitting face mask should be performed for 3 to 5 minutes before intubation.Intubation attempts should take no longer than 15 to 30 seconds.Applying cricoid pressure (Sellick maneuver) may decrease the incidence of pulmonary aspiration and gastric distention. This procedure is accomplished by applying firm, downward pressure on the cricoid ring, pushing the vocal cords downward so they are more easily visualized. Once begun, cricoid pressure must be maintained until intubation is completed.

EQUIPMENT:

Personal protective equipmentEndotracheal tube with intact cuff and 15 mm connector ( Adult female 7.5 to 8.0 mm tube, adult male 8.0 to 9.0-mm tube)Laryngoscope handle with fresh batteriesLaryngoscope blades (straight or curved)Spare bulb for laryngoscope bladesFlexible styletSelf-inflating resuscitation bag with mask connected to 100% oxygenOxygen source and connecting tubesNon-sterile glovesLuer-tip 10 ml syringe for cuff inflationWater-soluble lubricantRigid pharyngeal suction-tip catheterSuction apparatusSuction catheterET Tube tape (adhesive ( 6 to 8 in long)StethoscopeSedating or paralyzing medicationsForceps to remove foreign bodiesLocal anesthesia

PARTS OF A LARYNGOSCOPE

PARTS OF AN ENDOTRACHEAL TUBE

ENDOTRACHEAL INTUBATION

CHEST TUBE/THORACOSTOMY

INDICATIONS:

Drainage of hemothorax, or large pleural effusion of any causeDrainage of large pneumothorax (greater than 25%)Prophylactic placement of chest tubes in a patient with suspected chest trauma before transport to specialized trauma centerFlail chest segment requiring ventilator support, severe pulmonary contusion with effusion

MATERIALS

Chest tube with or without trocar or catheterChest tube suction unit tubing, suction machineChest tube tray to include scalpel blade and handle, large Kelly clamps, needle driver, scissorsPacket of 0 or 1.0 silk suture on a curved needleTape, gauze2% lidocaine with epinephrine, 20 cc syringe, 23-gauge needle for infiltrationSterile prep solution; mask, gown and gloves

CHEST TUBE INSERTION

Size of Chest Tube

Adult or Teen Male

28-32 Fr

Adult or Teen Female

28 Fr

Child 18 Fr

Newborn 12-14 Fr

Step 1: Incising the chest wall

Step 2: Opening the incision with a Kelly clamp

Step 3: Using a Kelly clamp to guide insertion of chest tube

Step 4: Inserting a chest tube

NASOGASTRIC INTUBATIONA nasogastric (na-so-gas-tric) tube is a thin soft tube that is passed through the nostril, down the back of the throat and into the stomach. 

Reason for insertion of NG

An NG is normally put in so that specially prepared liquid food can be put down the tube to feed the client. The reason may include:

If the client (pedriatric clients) has problems with their sucking and swallowing if your client is not getting enough nutrition through their normal diet If client cannot swallow medications they need Sometimes, an NGT may be put in to empty the stomach contents through

the tube. For gastric lavage

EQUIPMENTS

All necessary equipment should be prepared, assembled and available at the bedside prior to starting the NG tube. Basic equipment includes:

Personal protective equipment NG/OG tube Catheter tip irrigation 60ml syringe Water-soluble lubricant, preferably 2% Xylocaine jelly Adhesive tape Low powered suction device OR Drainage bag Stethoscope Cup of water (if necessary)/ ice chips Emesis basin pH indicator strips

STEPS

NASOGASTRIC TUBE

Size FG-8 FG-10 FG-12 FG-14 FG-16 FG-18 FG-20

Colour Code Blue Black White Green Orange Red Yellow

Size FG-8 FG-10 FG-12 FG-14 FG-16 FG-18 FG-20

Colour Code Blue Black White Green Orange Red Yellow

Size FG-8 FG-10 FG-12 FG-14 FG-16 FG-18 FG-20

Colour Code Blue Black White Green Orange Red Yellow

LEVIN TUBE