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Specific steps and precautions for endotracheal intubation

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Author : Joe Wong
Update time : 2021-01-14 10:50:13

Specific steps and precautions for endotracheal intubation

Tracheal intubation is a method of inserting a special endotracheal tube into the trachea or bronchus through the mouth or nasal cavity through the glottis. It provides the best conditions for airway patency, ventilation and oxygen supply, and airway suction. It is a rescue of patients with respiratory dysfunction. Important measures. It is now widely used in clinical treatment. Let me take a look at the specific steps and precautions of tracheal intubation with the editor!

A. Steps
1. In the supine position, with pillows under the shoulders and head backwards so that the mouth, throat and trachea are in the same longitudinal axis.

2. Holding the laryngoscope in the left hand, slowly insert it along the curvature of the dorsal tongue, gently pick up the epiglottis cartilage to the base of the tongue, and the glottis can be revealed. When the inhalation glottis is opened, the endotracheal tube is quickly inserted into the trachea by the right hand. Pull out the tube core, place the tooth pad, and exit the laryngoscope.

3. Check whether gas is discharged from the outer port of the tracheal tube with breathing, or whether the breath sounds of the lungs on both sides are the same. After confirming that the intubation is correct, fix it with the tooth pad. The insertion depth of the catheter into the trachea is 4 to 5 cm for adults, and the distance from the tip of the catheter to the incisor is 18 to 22 cm. 4. Inject 5 ml of air into the balloon at the tip of the catheter to close the gap between the catheter and the tracheal wall.

B. Complications
1. Excessive force or rough movements during intubation can cause tooth loss, or damage the mucous membrane of the nasal cavity or throat, causing bleeding. It can also cause dislocation of the mandibular joint.

2. The catheter is too thin and the inner diameter is too small, which can increase the airway resistance. Even the duct was blocked due to compression and twists. If the catheter is too thick or hard, it is easy to cause laryngeal edema and even granuloma of the larynx.

3. If the catheter is inserted too deeply into the bronchus, it can cause hypoxia and atelectasis on one side. When the catheter is inserted too shallowly, it may come out accidentally due to changes in the patient's position. Pay attention to changes in the position of the catheter during the operation.

C. Remark

1. The intubation operation must be gentle. Choose the size of the catheter so that it can easily pass through the glottis. If it is too thick or violently inserted, it will cause damage to the larynx and trachea. Too detailed is not conducive to breathing.

2. After the tip of the catheter passes through the glottis, go further 5-6cm, so that the cuff completely crosses the glottis, and don't enter the bronchus or esophagus by mistake.

3. Inflate the cuff to just close the gap between the catheter and the tracheal wall. Do not inject a large amount of air blindly to cause ischemic necrosis of the tracheal wall.

4. After placing the surgical position, try endotracheal suction and check whether the catheter is unobstructed.

D. Postoperative care
1. Keep the tracheal tube unobstructed and suck out secretions in time.
2. Keep the oral cavity clean. Patients who have left the tracheal intubation for more than 12 hours should receive oral care twice a day.
3. Strengthen the temperature management and humidification management of the airway.
4. Tracheal intubation is generally reserved for no more than 3 to 5 days, if further treatment is needed, it can be changed to tracheotomy.