Insertion Of An Endotracheal Tube

What is an endotracheal tube?

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

Why would someone need an endotracheal tube?

A person will need an ET tube if they are not able to breathe 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. While a person is in surgery, he may get medicines to relax him and make him fall asleep. These medicines make it hard for a person to breathe on their own. Having an ET tube allows the patient to get the oxygen he needs, and allows the caregiver to treat the patient. If you or a family member is going to have surgery, ask your caregiver for more information. This includes what will be done during the surgery, and how to get ready for it.

How will caregivers know how deep the endotracheal tube should go?

Special measurements may be done by the caregiver to learn how deep the ET tube should be placed. The measurements are taken from the side of the patient's mouth, to the side of his face and down to the middle of his chest. Once the measurements are taken, there are markings on the tube that show how deep the tube is placed.

What happens when the endotracheal tube is inserted?

Caregivers will give the patient extra oxygen before inserting the ET tube. Medicines will be given to help the patient relax and decrease his movement. The patient may be completely asleep before his caregiver inserts the ET tube. 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 be attached to the respirator, which will breathe for the patient.

How will caregivers know the endotracheal tube is in the right place?

The following may be done to check for proper tube placement:

  • Direct observation:

    • Breath sounds: The caregiver may listen to the patient's breath sounds to be sure they are heard clearly in both lungs.

    • Chest movement: The caregiver may watch the patient's chest rise and fall with each breath. Equal chest movement on both sides is a sign that breathing is occurring normally.

    • Direct visualization: The caregiver may watch the tube as it passes through the vocal cords into the trachea. Watching as the tube is placed can be done with a bronchoscope. A bronchoscope is a flexible tube with a light and camera on its end.

    • Tube fogging: A humidifier may be used to make the oxygen used through the respirator damp and warm. Humidified air may cause the ET tube to become foggy with each breath. If the tube is fogging while the patient is breathing, it is a sign that air is going in and out of the lungs.

  • Imaging tests:

    • Chest x-ray: The caregiver may use an x-ray to take pictures of the patient's chest. The x-ray pictures will show if the ET tube is in the correct position in the trachea.

    • Ultrasound: The caregiver may use an ultrasound test to watch the ET tube being inserted. An ultrasound is a test that looks inside of the body. Sound waves are used to show pictures of organs and tissues on a TV-like screen.

  • Measuring devices:

    • Carbon dioxide detectors: Carbon dioxide is a gas that is released when a person breathes air out (expiration) of their lungs. The caregiver may measure the levels of carbon dioxide with each of the patient's breaths. Measuring carbon dioxide levels can show that proper breathing is taking place.

    • Esophageal intubation detectors: The caregiver may attach a syringe to the outside end of the ET tube and try to pull out air. Air can only be pulled out if the ET tube is in the proper place in the patient's airway.

Will the person be awake with an endotracheal tube in his throat?

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.

What are the risks of having an endotracheal tube inserted?

  • During ET tube insertion, the patients 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.

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. 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.

© 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.

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