Endotracheal Intubation II: Nursing Management

Before intubation, nurses must familiarize themselves with equipment including the endotracheal tube, laryngoscope, and syringe. They should ensure the crash cart is accessible, verify that oxygen and suctioning devices function properly, insert an IV line for premedications, and confirm the patient and bed are positioned comfortably for the procedure. Proper hand hygiene and personal protective equipment for all team members are essential to prevent infection.

Nurses verify tube placement by auscultating both lung fields to confirm bilateral breath sounds. They monitor the patient's oxygenation levels and may order a chest X-ray or ABG test to confirm proper positioning. Once placement is verified, nurses inflate the cuff to the desired pressure and continue oxygenating the patient using a bag-valve manual resuscitator before connecting to mechanical ventilation.

Nurses must closely monitor cuff pressure to minimize tracheal necrosis risk and use a bite block to prevent tube biting. Regular oral care with antibacterial or antiseptic solution reduces infection risk. Turning the patient's head to the side and repositioning every 2 hours prevents aspiration and secretion stagnation. Frequent suctioning of oral secretions further reduces aspiration and infection complications.

Adequate humidity prevents oropharyngeal dryness and maintains airway integrity in intubated patients. Nurses should ensure a visible mist appears in the T-piece or ventilator tubing, indicating proper humidification. This moisture helps prevent secretion buildup and reduces airway irritation, supporting better respiratory function and patient comfort during mechanical ventilation.

Suctioning removes oral and pharyngeal secretions to prevent aspiration and reduce infection risk in intubated patients. Nurses should suction secretions as needed during and after intubation to maintain airway patency. Regular suctioning combined with frequent repositioning prevents secretion stagnation and supports optimal lung expansion, reducing complications like atelectasis.

After extubation, patients should initially be kept NPO (nothing by mouth) or given only ice chips for the first few hours. Nurses should educate patients on coughing and deep-breathing exercises to promote lung expansion and secretion clearance. Pain assessment and management using appropriate medications are essential, along with monitoring respiratory status and providing reassurance during the recovery period.

During intubation, nurses handle necessary equipment, monitor tube placement through auscultation, and assess patient oxygenation continuously. They assist in securing the endotracheal tube using tape or an ET holder and prepare the patient for connection to the mechanical ventilator. Nurses also suction secretions as needed and monitor for aspiration manifestations, ensuring smooth procedure completion and immediate post-intubation stabilization.