Endotracheal Intubation Overview

Study Notes

Definition: Inserting a tube directly into the trachea through the nose (nasotracheal) or mouth (orotracheal).
ETT Definition: Flexible plastic, curved tube inserted through nose or mouth to trachea.
Adult Male ETT Size: 7.5-8.5
Adult Female ETT Size: 6.5-7.5
Pediatric ETT Size: 4 + AGE/4
ETT Insertion Depth: 2-3 cm above carina.
Post-Insertion Confirmation: Chest X-ray for proper tube placement.
Duration of ETT Use: Controversial, but usually 2-4 weeks if artificial airway is still needed.
Nurse's Role: Patient assessment, monitoring vital signs, pulse oximetry, suctioning, and collaboration with other staff.
Indications for Intubation:
- Inadequate oxygenation (low arterial PO2) not corrected with supplemental O2.
- Need to control and remove pulmonary secretions.
- Pulmonary impairment (acute respiratory failure, COPD).
- Cardiovascular impairment (e.g., cardiac arrest).
- Neurological impairment (e.g., myasthenia gravis, poisoning).

Patient Assessment: Evaluate level of consciousness, anxiety, and respiratory difficulty. Assess history of trauma, especially spinal cord injury. Determine need for premedication.
Patient Preparation: Explain the procedure and reason for intubation to decrease anxiety. Initiate intravenous access before intubation. Administer pre-medication as ordered by the physician.
Position: Non-trauma patients in hyperextension (sniffing position). Trauma patients in fixed position (jaw thrust maneuver).
Nurse Preparation: Wash hands, wear gloves and mask. Insert oropharyngeal airway (only for unconscious patients). Set up suction apparatus. Remove dentures. Preoxygenate with 100% oxygen for 3–5 minutes. Assist physician during insertion as needed. Sweep tongue to one side and lubricate the laryngoscope with normal saline. Visualize vocal cords and larynx. Place the ETT into the trachea while attempting ventilation.

Monitor: Vital signs every 15-20 minutes until stable.
Assess: For hypoxemia, nasal bleeding, or tooth avulsion.
Monitoring: ABG (arterial blood gases) should be drawn 10–20 minutes post-intubation.
Position: Observe for signs of right bronchus intubation, decreased chest expansion, and decreased breath sounds on the left side.
Secure: Secure tube to the patient's face with adhesive tape.
Verify: Reconfirm placement and distance from proximal end of tube to the point where tube reaches the teeth (approximately 21 cm for women, 23 cm for men; normal weight and height).
Position Confirmation: Verify tube position by chest X-ray.
Cuff Pressure: Maintain cuff pressure at 20–25 mmHg.
Suction: Hyperoxygenate and suction endotracheal tube as needed
Inspect: Inspect nares or oral cavity once per shift while the patient is intubated.
Report: Report any change in breath sounds, cuff pressure, or inability to pass a suction catheter; assess for frothy or bloody secretions.

Trauma: Trauma/bleeding to nasal, oral, esophageal, tracheal, or laryngeal sites, Fractured teeth.
Arrhythmias: Transient cardiac arrhythmias.
Hypoxia: Hypoxia.
Aspiration: Aspiration
Tube Displacement: Displacement of tube (right mainstem intubation or gastric intubation),
Laryngeal Damage: Laryngeal damage, paralysis, and necrosis.