endotracheal intubation
DESCRIPTION
This is a powerpoint presentation containing 32 slides as a part of advanced nursing practice demonstration, in curriculum of First year M.Sc. Nursing.TRANSCRIPT
ENDOTRACHEAL INTUBATION
Presented by-
Indrakshi Basu
1st year, M.Sc. Nursing
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
Acute Respiratory
Failure
Pulmonary Obstructive
Disorder
Trauma & Injury
Structural Anomaly
Neuromuscular Disorder
Aspiration prophylaxis
Post-operative
Anaphylaxis
Need Airway Protection
CONTRAINDICATION
•Airway Trauma
•Cervical Spine Injury
•Mallampati classification (iii / iv)
MALLAMPATI CLASSIFICATION
DIFFICULT INTUBATION
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
CURVED 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 neonatesLaryngeal mask for difficult intubation
RESUSCITATION 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
During intubation
Spinal cord injury
Aspiration
Dental damage
Laceraton & perforation
Tube goes
cranial vault
Epistaxis
Delayed resuscitation
Corneal abrasion
Cartilage dislocatio
n
CARDIOVASCULAR COMPLICATIONS
* PSVT• VT• BRADYR
HYTHMIA
HYPERTENSIONHYPOTENSION
TUBE RELATED COMPLICATION
kink & block Dislodgement
Advancement in bronchus
Mechanical damage of upper airway
structure
POST INTUBATIONCOMPLICATION
Laryngospasm Laryngeal edema
Dysphonia Hemorrhage
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