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Endotracheal Intubation

the management of the patient with an airway catheter inserted through the mouth or nose into the trachea. May used to maintain a patent airway, to prevent aspiration of material from the digestive tract in the unconscious or paralyzed patient, to permit suctioning of tracheobronchial secretions or to administer positive pressure ventilation that cannot be given effectively by a mask. Endotracheal tube maybe made of rubber or plastic and usually has an inflatable cuff to maintain a closed system with of ventilator. What is the purpose of endotracheal intubation? he endotracheal tube serves as an open passage through the upper airway. he purpose of endotracheal intubation is to permit air to pass freely to and from the lungs in order to ventilate the lungs. Endotracheal tubes can be connected to ventilator machines to provide artificial respiration. his can help when a patient is unconscious and by maintaining a patent airway, especially during surgery. It is often used when patients are critically ill and cannot maintain ade!uate respiratory function to meet their needs. he endotracheal tube facilitates the use of a mechanical ventilator in these critical situations. Indications for Endotracheal Intubation "cute respiratory failure, #$% depression, neuromuscular disease, pulmonary disease, chest wall in&ury.'pper airway obstruction (tumor, inflammation, foreign body, laryngeal spasm)"nticipated upper airway obstruction from edema or soft tissue swelling due to head and neck trauma, some postoperative head an neck procedures involving the airway, facial or airway burns, reduced level of consciousness"spiration prophyla*is+racture of cervical vertebrae with spinal cord in&ury re!uiring ventilatory assistance. #ontraindication for Endotracheal Intubation When glottis is obscured by vomitus, bleeding, foreign body or trauma or cervical spine in&ury or deformity. #omplication of Endotracheal Intubation , laryngeal or tracheal injuryglottic edema sore throat, hoarse voice

ulceration or necrosis of tracheal mucosa vocal cord paralysis

vocal cord ulceratrion, granuloma or polpyspostextubation tracheal stenosis

tracheal dilation inominate artery erosion

formation of tracheal-esophageal fistula pulmonary infection and sepsis

dependence on artificial airway

If the tube is inadvertently placed in the esophagus (right behind the trachea), adequate respirations will not occur. rain damage, cardiac arrest, and death can occur. "spiration of stomach contents can result in pneumonia and "-.%. /lacement of the tube too deep can result in only one lung being ventilated and can result in a pneumothora* as well as inade!uate ventilation. .uring endotracheal tube placement, damage can also occur to the teeth, the soft tissues in the back of the throat, as well as the vocal cords. Endotracheal ube Insertion 0rotracheal insertion, technically easier because it is done under direct visualization. .isadvantages1 increase oral secretion, decrease patient comfort, difficulty with tube stabilization, inability of the patient to use lip movement as a communication means.$asotracheal insertion, maybe more comfortable to the patient and is easier to stabilize. .isadvantages1 blind insertion is re!uired, possible development of pressure necrosis of the nasal airaway, sinusitis and otitis media. $ursing #are and Management of Endotracheal Intubation Ensure ade!uate ventilation and o*ygenation through the use of o*ygen supplementation or mechanical ventilation as indicated ."ssess breath sounds every 2 hurs. $ote evidenced of ineffective secretion clearance which suggests needs for suctioning ./rovide ade!uate humidity within natural humidifying pathway of the orophayrn* is bypassed. /rovide ade!uate suctioning of oral secretions to prevent aspiration and decrease oral microbial colonization .'sed clean techni!ue when inserting an oral or nasopharyngeal airway, and take it out and clean it with hydrogen pero*ide and rinse with water at least every 3 hours. /erform fre!uent oral care with soft toothbrush or swabs and antiseptic mouthwash or hydrogen pero*ide diluted with water. +re!uent oral care will aid in prevention of ventilator,associated pneumonia .Ensure that aseptic techni!ue is maintained when inseting an E . he artificial airway bypasses the upper airway, and the lower airways are sterile below the level of the vocal cords. Elevate the patient to semi,fowler4s or sitting position when possible. hese position result in improved lung compliance. he patient position, however should be changed at least every 2 hours to ensure ventilation of all lung segments and prevent secretion stagnation and atlectasis. /osition changes are also necessary to avoid skin breakdown. If an oral or nasopharyngeal airway, is used , turn th e patient4s head to the side to reduced risk for aspiration.