Endotracheal Tube

Suctioning

Et tube, a foreign body in trachea, causes irritation and increase production of secretions

Suppress ciliar motion Diminishes the ability to cough and mobilize

secretions

Suctioning is a must

EndotrachealEndotracheal Tube SuctioningTube Suctioning

Endotracheal TubeSuctioning

Catheter size Suction length Frequency

Endotracheal TubeSuctioning

Lubricate catheter with

sterile water or

saline if necessary

Endotracheal TubeSuctioning

Catheter size:

6.5 Fr. for 2.5 mm I.D. ET tube 8.0 Fr. for 3.0 & 3.5 I.D. ET tube

Endotracheal TubeSuctioning

Suction length (main bronchi):

ET tube length (inside + outside)

+3 cm for 2000 gm

Endotracheal TubeSuctioning

Time:

As short as possible

Endotracheal TubeSuctioning

Pressure:

-100 to -200 cmH2O

(-80 to -150 mmHg)

1mmHg = 1.36 cmH2O

Endotracheal TubeSuctioning

Frequency:

Q 2-4 hr & prn

Endotracheal TubeSuctioning

Head position:

Turn to left side for suction of right main stem bronchus

Turn to right side for suction of left main stem bronchus

Name:___________________________

Length(C-H):_____________________

Depth of suction: __ cm. = NTT length

(__cm. Inside + __cm. Outside) + 3 to

5cm. (3 cm for 1000 gm premie and 5

cm. for term infant)

NTT size:________________________

Nurse signature:___________________

Date:____________________________

Chest Physical Therapy

Percussion

Vibration

Problems of Airway (short list)Problems of Airway (short list)

Laryngeal web

Subglottic stenosis

Hemangioma

Vascular anomalies (rings/slings)

Tracheal stenosis

Complete tracheal rings

Laryngeal webLaryngeal web

SubglotticSubglottic stenosisstenosis

HemangiomaHemangioma

Vascular anomalies (rings/slings)Vascular anomalies (rings/slings)

Tracheal Tracheal stenosisstenosis

Complete tracheal ringsComplete tracheal rings

photo from Colour Atlas of ENT Diagnosis; by T.R. Bull, p 197

Laryngeal webLaryngeal web

Congenital lesion

Incomplete epithelial reabsorption larynx (week 8)

75% glottic level involving vocal cords

Abnormal cry, stridor, respiratory distress

Small webs rarely require treatment

Large, symptomatic ones removed by endoscopic laser/knife

Congenital lesionCongenital lesion

Incomplete epithelial Incomplete epithelial reabsorptionreabsorption larynx larynx (week 8)(week 8)

75% 75% glotticglottic level level involving vocal cordsinvolving vocal cords

Abnormal cry, Abnormal cry, stridorstridor, , respiratory distressrespiratory distress

Small webs rarely Small webs rarely require treatmentrequire treatment

Large, symptomatic Large, symptomatic ones removed by ones removed by endoscopic laser/knifeendoscopic laser/knife

SubglotticSubglottic stenosisstenosis

From vocal cords to cricoid cartilage

Definition: (diameter)