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Insertion Of An Endotracheal Tube

WHAT YOU SHOULD KNOW:

  • An endotracheal (ET) tube is a hollow plastic tube that is placed in the trachea through the mouth. The trachea is a tube inside the body that goes from the throat to the lungs. The trachea is also called the windpipe or airway. The ET tube is attached to a machine called a respirator. A respirator gives a person oxygen (air), and breathes for him when he cannot breathe on his own.
    Proper Endotracheal Intubation


  • A person will need an ET tube if they are not able to breathe in enough oxygen for their body. This can occur if he has an injury, serious illness, or cardiac arrest (heart attack). An ET tube may also be used during surgery. Having an ET tube allows the patient to get the oxygen he needs, and allows the caregiver to treat the patient. Having an ET tube placed may save a person's life.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • During ET tube insertion, the patient may have abnormal heartbeats. The tube may cause damage to the patient's mouth, teeth, larynx (voice box), or trachea. The tube may be placed into the esophagus (passage from the mouth to the stomach). If this occurs, the patient may vomit and food or fluid may enter his lungs (aspiration). If the patient aspirates, he may get a lung infection. Having an ET tube for a long period of time also may lead to a lung infection. The tube also may be put too far into the patient's airway, or become dislodged. If the ET tube is not in the right area of his trachea, the patient may not get the oxygen he needs. Decreased levels of oxygen can lead to permanent organ or brain damage, and death.

  • When a person is not able to breathe well on their own, an ET tube is needed. Choosing not to have an ET tube placed will lead to decreased oxygen levels in the body. Decreased oxygen may lead to organ and brain damage, and may cause death.

WHILE YOU ARE HERE:

Informed consent:

The patient has the right to understand his health condition in words that he knows. He should be told what tests, treatments, or procedures may be done to treat his condition. His caregiver should also tell the patient about the risks and benefits of each treatment. The patient may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If the patient is unable to give his consent, someone who has permission can sign this form for him. A consent form is a legal piece of paper that tells exactly what will be done to the patient. Before giving his consent, make sure all the patient's questions have been answered so that he understands what may happen.

IV:

An IV is a tube placed in the patient's vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Heart monitor:

This is also called an ECG, electrocardiogram, or telemetry. Three or five sticky pads are placed on the patient's chest. Each pad has a wire leading to a TV-type screen, or to a small portable box (telemetry unit). This screen or box shows a picture of the patient's heartbeat. Caregivers watch this picture to make sure the patient's heart is doing okay.

Pulse oximeter:

A pulse oximeter is a machine that tells caregivers how much oxygen is in the patient's blood. A cord with a clip or sticky strip is placed on the patient's foot, toe, hand, finger, or earlobe. The other end of the cord is hooked to a machine. The machine will alarm if it cannot read the oxygen level, or if the patient needs more oxygen.

For patients having surgery:

If the patient is having surgery, he will be taken to the room where the surgery will be done. He will then be moved to an operating table or bed. Anesthesia medicine may be given to the patient before the ET tube is put in. Anesthesia medicine is given to help the patient fall, and stay asleep during his surgery. After surgery, the patient will be taken to a room where he can rest. The ET tube may be removed by a caregiver before the patient is fully awake.

Before endotracheal tube insertion:

Before inserting an ET tube dentures will be removed from patient's who have them. The patient will then be given extra oxygen for about three minutes. The extra oxygen allows the patient's body to have enough oxygen while the tube is being placed. The patient may also get medicines to keep him calm and sleepy while the tube is put in. The patient may get the following:

  • Medicines:

    • Topical anesthesia: This medicine may be sprayed into the back of the patient's mouth to numb (decrease feeling) the area.

    • Sedative medicine: This medicine may be given to help the patient be calm and relaxed.

    • Paralytic medicine: This medicine may be given to stop the patient's muscles from tightening up.

During endotracheal tube insertion:

  • The ET tube may be put in with a stiff device to help guide it into place. The tube will be put into the patient's mouth, past his vocal cords, and into his trachea. Once the tube is in place, the stiff guiding device will be removed. The tube may have a balloon at the end that is filled with air to hold it in place. The tube will be secured to the patient's mouth with special tape. The ET tube will then be attached to the respirator, which will breathe for the patient.

After endotracheal tube insertion:

After the ET tube is put in, the caregiver will check to be sure it is in the right place. He will listen for breath sounds in the lungs, and watch for chest movement. He may measure the level of carbon dioxide the patient is breathing out. The caregiver also may try to pull air out from the ET tube with a syringe. A small camera may be put down into the ET tube to check placement. Caregivers also may use an ultrasound or x-ray to check if the ET tube is in the proper place.

Endotracheal tube removal:

When the patient is able to breathe on his own, caregiver's may remove the ET tube. The patient may be awake before the tube is removed. If the patient is awake, it is important for him to follow his caregiver's instructions closely. Following instructions will help the patient stay calm while caregivers get ready to remove the ET tube.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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