Endotracheal Tubes: Indications & Patient Management

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  • 0:04 Emergency
  • 0:42 Endotracheal Tube Indications
  • 2:43 Endotracheal Tube Management
  • 4:13 Lesson Summary
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Lesson Transcript
Instructor: Alexandra Unfried

Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.

Endotracheal tubes are inserted into the airway when a patient is unable to breathe on his/her own. This lesson plan will discuss the reasons why an endotracheal tube is needed and how to manage the patient.

Respiratory Emergency

Rachael has severe asthma attacks occasionally. Lately, she has been having trouble managing her symptoms and medications appropriately. She presents to the emergency room in respiratory distress. The medical team sees that Rachael is at risk for respiratory fatigue because she is working too hard to breathe. They have tried the usual asthma treatments such as nebulizers, corticosteroids, and bronchodilators to expand her airway. She is showing signs of respiratory failure and is starting to lose consciousness. The doctor decides that she needs to be intubated, a process where an endotracheal tube is inserted into the airway to assist with breathing.

Endotracheal Tube Indications

An endotracheal tube is a tube that is placed through the nose or mouth and inserted down the trachea into the lungs. The tube is usually connected to a machine called a ventilator, which pushes oxygenated air into the lungs. The patient may or may not be awake and conscious during the procedure, but will be sedated or given medication during and after intubation. This is so the tube is not accidentally removed by the patient.

An endotracheal tube is usually inserted during an emergency. Intubation is performed for the following reasons:

  • To open the airway for oxygenation, medication, and anesthesia
  • To remove any blockages in the airway
  • To protect the airway and lungs in those with conditions such as overdoses, strokes, or bleeding in the gastrointestinal tract
  • To support the airway and breathing in those with conditions such as heart failure, trauma, collapsed lung, pneumonia, pulmonary edema, pulmonary embolism, and emphysema
  • To keep the airway open during times of inflammation in the upper airway or trauma to the neck
  • To provide oxygen when there is a loss of consciousness to prevent aspiration of vomit, blood, and secretions (aspiration is when fluids or particles are breathed into the lungs, which can cause respiratory distress and infection)
  • To support the airway in those who are too fatigued to do so due to status asthmaticus or chronic obstructive pulmonary disease (COPD)
  • To provide a functioning airway when someone is declining and offer more control to the medical staff over the patient (examples of these would be stab wounds to the throat or neck, septic shock, hard to control trauma patients, bleeding in the brain, cervical spine fracture)

Process of placing the endotracheal tube into the mouth
Process of placing the endotracheal tube into the mouth

Rachael has an endotracheal tube placed to support her airway during her asthma attack. She has been struggling to get enough oxygen in her body and is starting to get too tired to breathe effectively. Once the doctor completes the intubation, the nurse is ready to manage Rachael.

Endotracheal Tube Management

An endotracheal tube is usually a temporary airway support. Once the emergency is resolved and the patient is able to breathe on his/her own, the tube will be removed. Otherwise, a tracheostomy is placed for long-term airway support. The nurse or respiratory therapist is responsible for maintaining the endotracheal tube. This is done by:

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