Endotracheal tube why

Apply market research to generate audience insights. Measure content performance. Develop and improve products. List of Partners vendors. An endotracheal tube is a flexible plastic tube that is placed through the mouth into the trachea windpipe to help a patient breathe. The endotracheal tube is then connected to a ventilator, which delivers oxygen to the lungs.

The process of inserting the tube is called endotracheal intubation. There are many reasons why an endotracheal tube may be placed, including surgery with a general anesthetic, trauma, or serious illness.

Learn about the procedure, potential risks and complications, and what you might expect. An endotracheal tube is placed when a patient is unable to breathe on their own, when it is necessary to sedate and "rest" someone who is very ill, or to protect the airway. The tube maintains the airway so that air can pass into and out of the lungs. There are a number of indications for placement of an endotracheal tube that can be broken down into a few broad categories.

These include:. General surgery: With general anesthesia , the muscles of the body including the diaphragm are paralyzed, and placing an endotracheal tube allows the ventilator to do the work of breathing.

Foreign body removal: If the trachea is obstructed by a foreign body that is aspirated breathed in , an endotracheal tube may be placed to help with the removal of the foreign object.

To protect the airway against aspiration: If someone has a massive gastrointestinal bleed bleeding in the esophagus, stomach, or upper intestine or suffers a stroke, an endotracheal tube may be placed to help prevent the stomach contents from entering the airways. If the stomach contents are accidentally breathed in, a person may develop aspiration pneumonia, a very serious and potentially life-threatening disease.

To visualize the airway: If an abnormality of the larynx, trachea, or bronchi is suspected, such as a tumor or a congenital malformation birth defect , an endotracheal tube may be placed to allow careful visualization of the airways.

After surgery: After surgery on the chest such as lung cancer surgery or heart surgery, an endotracheal tube connected to a ventilator may be left in place to help with breathing after surgery. In this case, a person may be "weaned" from the ventilator at some time during recovery.

To support breathing : If someone is having difficulty breathing due to pneumonia, a pneumothorax collapse of a lung , respiratory failure or impending respiratory failure, heart failure, or unconsciousness due to an overdose, stroke, or brain injury, an endotracheal tube may be placed to support breathing.

Some medical conditions especially neurological conditions can result in full or partial paralysis of the diaphragm and may require respiratory support. Examples include amyotrophic lateral sclerosis , Guillain-Barre syndrome , and botulism.

The diaphragm may also become paralyzed due to damage or pressure on the phrenic nerve related to trauma or a tumor in the chest. When sedation is required: If strong sedatives are needed, such as when a person is very ill, an endotracheal tube may be placed to assist with breathing until the sedatives can be discontinued. In premature babies: Respiratory distress in premature babies often requires placement of an endotracheal tube and mechanical ventilation.

When a higher concentration of oxygen is needed: Endotracheal tube placement and mechanical ventilation allows for the delivery of higher concentrations of oxygen than found in room air. If you will be having surgery with a general anesthetic, quitting smoking even a day or two before the surgery can lower your risk of complications. Endotracheal tubes are flexible tubes that can be made from a number of different materials. Though latex tubes are not commonly used, it's important to let your healthcare provider know if you have a latex allergy.

Endotracheal tubes come in a number of different sizes ranging from 2. In general, a 7. Newborns often require a 3. In an emergency, healthcare providers often guess at the right size, while in the operating room the size is often chosen based on age and body weight. Single and double lumen tubes are available, with single lumen tubes often used for lung surgery so that one lung can be ventilated during surgery on the other lung. Before an endotracheal tube is placed, your jewelry should be removed, especially tongue piercings.

People should not eat or drink before surgery for at least six hours to reduce the risk of aspiration during intubation. The procedure for placing an endotracheal tube will vary depending on whether a person is conscious or not.

An endotracheal tube is often placed when a patient is unconscious. If a patient is conscious, medications are used to ease anxiety while the tube is placed and until it is removed. Precise steps are usually used during intubation. First, the patient is preoxygenated with percent oxygen ideal is five minutes to give the intubator more time to intubate.

An oral airway may be used to keep the tongue of the way and reduce the chance that the patient will bite the ET tube. During surgery, the anesthesiologist will want to make sure the patient is completely paralyzed before inserting the tube to reduce the chance of vomiting during placement and subsequent complications.

With patients who are awake, and anti-nausea drug antiemetic may be used to decrease the gag reflex, and anesthesia may be used to numb the throat. In some cases, a nasogastric tube may need to be placed before intubation, especially if blood or vomit is present in the patient's mouth. In the emergency department, healthcare providers usually make sure they are prepared to perform a cricothyrotomy if intubation is not effective. During intubation, a healthcare provider usually stands at the head of the bed looking towards the patient's feet and with the patient lying flat.

The positioning will vary depending on the setting and whether the procedure is being done with an adult or child. With children, a jaw thrust is often used. The endotracheal tube with the assistance of a lighted laryngoscope a Glidescope video laryngoscope is particularly helpful for people who are obese or if a patient is immobilized with a suspected injury to the cervical spine is inserted through the mouth or in some cases, the nose after moving the tongue out of the way.

The scope is then carefully threaded down between the vocal cords and into the lower trachea. When it's thought that the endotracheal tube is in the proper location, the healthcare provider will listen to the patient's lungs and upper abdomen to make sure that the endotracheal tube was not inadvertently inserted into the esophagus.

Other signs that suggest the tube is in the proper position may include seeing chest movement with ventilation and fogging in the tube. It therefore appropriate to use this technique when caring for patients with infectious respiratory conditions. Normal saline should not be routinely instilled prior to ETT suction in infants. It should only be instilled in infants who have thick, tenacious secretions. The amount of normal saline to use is 0. Each infant should be assessed individually regarding whether this is necessary.

This should be decreased as soon as possible after suction is complete. Recruitment post-suction should not be routine, however:. If the oxygen saturations are not improving in the two minutes after suction increasing the PEEP by 1 cmH2O should be discussed with the Medical Staff. Each infant should be assessed individually regarding whether hyperventilation pre-suction is necessary.

Hyperventilation pre-suction should not be routine, but:. Using the ventilator setting, rate is increased by breaths above baseline immediately prior to suction, and continues after suction is complete until the infant returns to the pre-suction oxygen saturation and ETT or transcutaneous CO 2 if monitored level.

Care should be taken to ensure the rate is reduced to baseline as soon as possible after ETT suction. It is the responsibility of the clinician caring for the infant requiring ETT suction to ensure that the parents understand the rationale for the procedure, as well as potential complications. Parents can help to support, contain and comfort the neonate while the nurse is carrying out the procedure.

Some infants may require a pre-suction bolus of analgesia or sedation where the need is anticipated, however urgent suction should not be deferred.

The need for this intervention is based on clinical assessment. Nursing comfort measures, such as positioning and containment, should also be utilized following the suction procedure. The need for this intervention is not routine, and where appropriate should be ordered by medical staff.

This is a two person procedure. For infants on HFOV, mean airway pressure is increased 2cmH2O above baseline for approximately two minutes after suction is complete, or until the infant returns to the pre-suction oxygen saturation level. Care should be taken to ensure the mean airway pressure is reduced to baseline as soon as possible after ETT suction.

For infants on HFJV, conventional ventilator rate may be increased by breaths above baseline immediately prior to suction, and continues after suction is complete until the infant returns to the pre-suction oxygen saturation and transcutaneous CO 2 if monitored level.

When caring for patients on HFJV, ideally the jet ventilator should be put on hold while suctioning and then press the enter button when the procedure is complete. This step prevents the jet ventilators alarms from shutting down the ventilator during suction. There are, however, occasions where this may not be possible due the instability of the patient you are caring for. There is no need to disconnect from the ventilator as you can suction through the port of the ventilator tubing. Disconnection of a ventilation circuit with iNO therapy should be avoided and so the use of an in-line suction port is most suitable.

Suction of the ETT should be done swiftly to avoid de-recruitment of the lungs. Use aseptic technique and personal protective equipment. Suction catheters should be discarded following each suction event, in order to reduce the risk of introducing infection.

Where possible, ETT suction is a two person procedure. The primary clinician suctions the ETT maintaining infection control precautions. The assistant ensures the infant remains safe from accidental extubation, adjusts ventilator settings if necessary, and provides containment and comfort to the infant.

Please remember to read the disclaimer. Updated May The Royal Children's Hospital Melbourne. Endotracheal tube suction of ventilated neonates. Endotracheal intubation is a medical procedure in which a tube is placed into the windpipe trachea through the mouth or nose.

In most emergency situations, it is placed through the mouth. Whether you are awake conscious or not awake unconscious , you will be given medicine to make it easier and more comfortable to insert the tube.

You may also receive medicine to relax. The provider will insert a device called a laryngoscope to be able to view the vocal cords and the upper part of the windpipe. If the procedure is being done to help with breathing, a tube is then inserted into the windpipe and past the vocal cords to just above the spot where the trachea branches into the lungs. The tube can then be connected to a mechanical ventilator to assist breathing. The procedure is most often done in emergency situations, so there are no steps you can take to prepare.

You will be in the hospital to monitor your breathing and your blood oxygen levels. You may be given oxygen or placed on a breathing machine. If you are awake, your health care provider may give you medicine to reduce your anxiety or discomfort. Casey DF.