Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.
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)
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:
- Ensuring proper equipment is available (such as suctioning equipment, medication, securement devices, the ventilator, and the manual ventilator)
- Assessing the patient's respiratory status at least every two hours
- Evaluating the nose and mouth area for irritation
- Keeping the tube secured and checking placement frequently
- Positioning the patient to support the airway and repositioning every two hours to maintain skin integrity
- Providing oral care by swabbing the patient's mouth with antiseptics at least every four hours and suctioning excess secretions as needed
- Making sure the patient has a way to communicate their needs through a communication board, whiteboard, or pen and paper
- Communicating with the health care team about any abnormalities
The nurse is taking care of Rachael by assessing her mouth and nose for positioning, equipment placement, and suctioning needs. The medications that she is receiving are returning her airway to normal. The endotracheal tube is removed after two days when Rachael is able to breathe on her own. The pulmonologist meets with Rachael before she can go home to adjust her asthma medications for better control.
Let's take a brief moment to review what we've learned in this lesson.
An endotracheal tube is a device placed through the nose or mouth and inserted down the trachea into the lungs. The tube helps support the airway by providing adequate oxygen to the body when the patient is unable to do so. It's usually temporary until the patient can breathe on their own or get a more permanent airway support. The endotracheal tube is connected to a ventilator, which is a machine that controls the breathing.
There are many indications to place an endotracheal tube, including providing airway support during trauma, illness, inflammation, certain conditions, and preventing aspiration, which is when fluids or particles are breathed into the lungs, which can cause respiratory distress and infection. Management of an endotracheal tube consists of making sure the tube stays in place and does not irritate the face, having the necessary equipment available, and completing oral care and suctioning.
Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.
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