Endotracheal Intubation II: Nursing Management

Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.

1. Nursing Care of Patients Before Intubation

Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation equipment, such as the endotracheal tube, laryngoscope, and syringe, as well as premedications, including sedatives, anesthetics, and muscle relaxants. Observing proper hand hygiene is crucial to preventing infection, and nurses must ensure that the entire healthcare team is appropriately dressed in personal protective equipment (PPE).

Preparation also involves ensuring the emergency cart is accessible and preparing the patient for the procedure. If the patient does not have intravenous access, the nurse should immediately insert a line for premedication. The patient and the bed should be positioned comfortably for the physician performing the procedure. Additionally, nurses must ensure that all equipment, such as oxygen and suctioning devices, functions correctly.

2. Nursing Care of Patients During Intubation

During the intubation, nurses assist the physician and handle the necessary equipment. They should verify the tube's position by auscultating both lung fields and monitoring the patient's oxygenation. Once the tube is correctly placed, they should inflate the cuff to the desired pressure and continue to oxygenate the patient using a bag-valve or manual resuscitator.

Nurses are also responsible for securing the tube using tape or an ET holder and suctioning the patient's secretions as needed. The patient should be attached to the mechanical ventilator, and a chest x-ray or ABG test may be ordered to confirm tube placement and adjust ventilator settings accordingly.

It is essential to monitor for manifestations of aspiration, maintain high humidity (a visible mist should appear in the T-piece or ventilator tubing), administer the prescribed oxygen concentration, and ensure regular repositioning of the patient to prevent atelectasis and optimize lung expansion.

3. Nursing Care of Patients After Intubation

After intubation, nurses should ensure patients receive the prescribed oxygen support and regularly assess their respiratory status, including lung sounds and secretions. Adequate humidity should be provided to avoid dryness in the oropharynx, and secretions should be suctioned orally to prevent aspiration and reduce the risk of infection.

Nurses should also closely monitor cuff pressure to minimize the risk of tracheal necrosis, provide frequent oral care using an antibacterial or antiseptic solution, and use a bite block if necessary to prevent the patient from biting the tube. The patient's head should be turned to the side to reduce the risk of aspiration, and they should be repositioned every 2 hours to prevent secretion stagnation.

4. Nursing Care of Patients After Extubation

Patients should initially be kept NPO (nothing by mouth) or given only ice chips for the first few hours post-extubation. Nurses should provide education about how to perform coughing and deep-breathing exercises, and assess and manage any pain experienced by the patient, using appropriate medications as indicated.