ET Care Management Alaine de Leon, RN LCP
Outline of presentation:
Background on ET Intubation
Definition
Indications Et care management
Background on Intubation
Endotracheal intubation
is a medical procedure in which a tube is placed into the windpipe (trachea), through the mouth or nose.
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Indications:
Endotracheal intubation is done to:
Open the airway to give oxygen, medication, or
anesthesia
Remove blockages from the airway Allow the doctor to get a better view of the upper
airway
Protect the lungs in certain patients
Complications of ET intubation: edema; bleeding; tracheal and esophageal perforation;
pneumothorax (collapsed lung); and aspiration.
Subcutaneous emphysema- repeated attempts at blind
advancement of endotracheal tube, created a raw area on the posterior tracheal wall may have resulted in a high intrathoracic pressure and disruption of the injured site. Subsequent high negative intrathoracic pressure generated might have entrained air along the sides of the tube through the tracheal rent into the subcutaneous tissue causing subcutaneous emphysema
ET care management
Endotracheal tube
management consists of ensuring a patent (open and unblocked) airway, suctioning pulmonary and oral secretions, and providing frequent oral and/or nasal care.
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Preparations:
Any needed supplies for endotracheal tube care should
be at the bedside prior to beginning the procedure. This includes a sterile suction kit, a bottle of sterile 0.9% sodium chloride, sterile gloves, a clean bite block if necessary, and tape already torn into appropriatelysized pieces.
It is recommended that another health care
professional firmly hold the endotracheal tube in place during any activity that requires loosening the straps that hold the tube
The patient should also be preoxygenated with 100%
Procedure:
1. Explain the procedure to the patient.
2. Gather equipment's : disposable clean gloves,
tape/plaster , trache tie, oral antiseptic solution, cotton balls or gauze, acetone or adhesive remover, bite block(oral airway), 5 cc or 10 cc disposable syringe, kidney basin, clean face towel, basin with water soap.
3. Hand hygiene/ wash hands.
4. Position the patient in a lateral position facing you
with head of bed elevated about 30-45 degrees. Position should facilitate easy removal/replacement of
Procedure:
9. Reposition tube, gently sliding it on the opposite of
the mouth at each change.
10. tape the airway in place, secure further with tie , tie
around the head. Do not anchor tie over the ears to prevent skin breakdown on the area.
11. Monitor air pressure in the ET. If its >20mmHg,
tracheal necrosis may result. Deflate and re-inflate cuff according to manufacturers direction.
12. Repeat suction orally and/ET. Check for proper tube
placement .
Procedure
Taping technique protocol
ET ( Endotracheal tube)
a. ADULT (age range) Technique : 2 Split Chevron Technique Tape : Silk Tape or Cloth Tape Size : 1 inch APPLICATION a. Prep the ET tube site according to your
Procedure
REMOVAL
a. Last to apply first to remove.
b. Lift the tape from the upper of lower lip, low and slow considering the hair growth. c. Using the removed tape, stick it to the edge of the untorn portion to lift the edge. Remove it low and slow following the direction of the hair growth. d. Remove the tape looped from the tube, gently.
After care:
All waste should be properly disposed of, either in the
garbage or a biohazard container. The respiratory status of the patient should be reassessed.
The insertion point (in centimeters) of the
endotracheal tube should be confirmed to be the same as prior to the procedure, unless the purpose of the procedure was to change the depth of the tube.
Complications:
The greatest risk of manipulating the endotracheal
tube is that it may be inadvertently removed, causing the patient to experience respiratory distress.
"Finish each day and be done with it. You have done what you could.
Some blunders and absurdities no doubt crept in; forget them as soon as you can. Tomorrow is a new day; begin it well and serenely and with too high a spirit to be cumbered with your old nonsense."
-- Ralph Waldo Emerson
THANK YOU!!!
