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ENDOTRACHEAL TUBE (ET Tube)

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  • 1.ENDOTRACHEAL TUBE (ET Tube)

2. Endotracheal tubes are curved tubes used forintubation Tubes were previously made up of latex (indianrubber) and those still available , currently plastictubes (PVC) are preferred because of followingadvantages : Disposable (less chances of infection) Hypoallergenic ( since latex allergy is fairlycomman) Transparent (easy visualization of blockage ETTdue to blood , pus , secretions 3. THE ET TUBE HAS THE FOLLOWINGCOMPONENTS : PROXIMAL END 15mm adapter (connector)which fits to ventilator or ambu bag CENTRAL PORTION 1. A vocal cord guide (black line ) which should be placed at the level of the opening of the vocal cords so that the tip of the ET tube is positioned above the bifurcation if the trachea.2. A radio-opaque marker which is essential for accurate visualization of the position of the ET tube within the trachea by means of an X-ray 4. 3. The distance indicator (marked in centimeters) which facilitates placement of ET tube.4. A cuff- incase of cuff ET tube DISTAL END has Murphys eye (opening in the lateral wall ) which prevents complete blockage of ET tube incase the distal end is impacted with secretion , blood , etc. 5. TYPES ET tubes can be :- cuffed- uncuffed Cuffed ET tubes are used in children > 8 years The cuff when inflated maintains the ET tube in properposition and prevents aspiration of contents from GItract into respiratory tract In children < 8 uncuffed ET tubes are used because thenarrow subglottic area performs the function of a cuffand prevents the ET tube from slipping. 6. High volume Low volumeLow pressure cuff High pressure cuff 7. SIZE From 2mm to 16 mms (internal diameter ) The size of the tube can be determined by internal diameter of ETT (mm) = age in years +44 Roughly the diameter of the childs little finger isthe same as that required for the ETT The following table gives an idea abpout the sizeof ETT in different age groups. 8. AGE GROUP SIZE OF ET TUBEPREMATURE BABIES 2 TO 2.5 FULL TERM BABIES UPTO 2 3 TO 3.5 WEEKSFROM 2 WEEKS TO 24 WEEKS 4 TO 4.5FROM 6 MONTHS TO 124.5 TO 5MONTHSThen increase the size of the ET tube by 0.5cms for every 6 months rise in age so that atapproximately 6 years of age size of the ETtube to be used is approximately 8 mms 9. USES For Mechanical Ventilation For Intermittent Postive Pressure Ventilation(IPPV) During resuscitation Direct suctioning of trachea in meconiumaspiration In Epiglottits &life threatening croup In tetanus (however for long term bases,tracheostomy is preferable) In diptheria In angioneurotic edema 10. COMPLICATIONS Mechanical trauma to tongue, teeth , palate ,pharynx & larynx during intubation procedure Stimulation of posterior of posterior pharyngealwall leading to coughing , vomiting or vasovagalepisode with resultant hypoxia , bradycardia. Prolonged intubation may cause pressurenecrosis of laryngeal structures leading topersistant hoarseness ( hence tracheostomy) isindicated in patients requiring long-termmechanical ventilation) Pneumothorax. 11. AMBU BAG PARTS OF THE AMBU BAG PATIENT OUTLET (to which mask is attached ) ONE-WAY VALVE UNIT (just proximal topatient outlet ) PRESSURE RELEASE VALVE Attachment site for manometer 12. size : the size of the bag varies depending onthe volume ( ranges from 250 ml to 750 ml forpaediatric use) pressure release valves : are usually set torelease at pressure of 30-35cms of water at the end there are two inlets OXYGEN INLET : This inlet is attached to atube carrying oxygen from the source (centraloxygen line or oxygen cylinder ) AIR INLET : if kept open the concentration of02 is approx 40% FiO2. for the Fi02 to be near90-100% , and oxygen reservoir should beattached. 13. MECHANISM OF VENTILATION in the resting stage the ambu bag is filled with air. On squeezing the bag to initiate ventilation theone wave valve proximal to the patients outletopens resulting in release of air , stored in thebag to the patient. On releasing the pressure thebag gets re-inflated with air. The patients exhaledair cannot re-enter the bag due to one wavemechanism of the valve at the patient outlet.USES : for giving intermittent positive pressureventilation