Assisting with Endotracheal Intubation

DEFINITION:
Passage of an endotracheal tube through the nose or mouth into the trachea.

3. SCOPE:
This procedure applies to all nurses working in RMC ICU

4. PURPOSE:
1. To maintain adequate oxygenation
2. To facilitate mechanical ventilation
3. To provide access for suctioning of excessive secretions in the respiratory tract of those patients who are unable to cough.
4. During anesthesia
5. Serves as a definitive means of emergency airway control for unconscious patients.

5. POLICY:
1. Only a medical practitioner is authorized to perform intubation of a patient. The role of the nurse is to assist.
2. Sedatives as well as muscle relaxants must be kept ready
3. Aseptic technique must be observed throughout
4. Infection control policies must be adhered to

6. EQUIPMENT:
1. endotracheal tube (correct size)
2. Functioning Laryngoscope
3. Stylet (Sterile)
4. Ambubag with well fitting mask
5. Lubricating jelly
6. Airway (correct size)
7. Suction machine
8. Suction catheter
9. Plaster
10. Gauze bandage
11. Sterile gloves
12. Scissors
13. Stethoscope
14. lOml syringe

7. PROCEDURE:
1. Take trolley to patients bedside
2. Place patient in a dorsal position without pillows
3. Open ET tube syringe and gloves without contaminating them (contd)
4. Wash and dry hands
5. Put on sterile gloves (Optional)
6. Test ETT for leak by injecting air, then deflate
7. Lubricate cuff end of ETT generously with jelly making sure not to contaminate it
8. Ventilate patient with ambubag connected to oxygen source
9. Doctor will wash and dry hands and put on sterile gloves
10. Assist Doctor to insert ETT.
a. Give well lighted Laryngoscope to doctor with the blade pointing downwards and facing the doctor.
b. Doctor will insert the Laryngoscope
c. Give the ETT to doctor to insert after he has visualized the vocal cords
d. Doctor will remove the Laryngoscope after inserting the ETT
e. Connect the ambubag to ETT and ambubag patient while the doctor auscultates the chest to ascertain equal air entry to both lungs. Observe for chest expansion
f Mark level of E.T.T as ordered by inubating doctor
g. Inflate ETT cuff with air to occlude the trachea and prevent leakage of air
h. Insert orophatygeal airway if necessary
I. Secure the tube firmly with adhesive type or gauze bandage
J Suction secretions if necessary
k. Connect ETT properly to ventilator making sure that there is no traction on the tube
11. Make patient comfortable
12. Clean trolley
13. Wash and dry hands

8. PRECAUTIONS:
a. Observe frequently for unnecessary movement of the tube as this will cause ulceration
b. Entry site (nose /mouth) should be kept clean and free of secretions
c. Balloon should always be kept inflated unless otherwise stated to prevent leakage of air and accidental extubation.



9. NURSING DOCUMENTATION:

Record:
a. Date, time of intubation and the **************** of the doctor who carried out the procedure.
b. Size, level of ETT and cuff pressure
c. Whether patient was attached to ventilator. If so, record settings.
d. Condition, patient before, during and after the procedure
e. **************** of intubator