-
Define endotracheal intubation.
passage of a specialized tube through the mouth and into the trachea.
-
What are the different names for an endotracheal tube?
-
Should the patient be concious or unconcious when placing the tube?
unconscious
-
What does the endotracheal tube bypass?
dead space
-
What are the different purposes of a trach tube?
- open airway
- deliver O2 and anesthetic gases
- assist ventilation (breath for them when we need to)
-
What are the different types of trach tubes?
- red rubber tube
- vinyl plastic tube
- silicone rubber tube
- spiral tube
-
Describe the red rubber tube.
- cheap
- common
- opaque
- may absorb disinfectant
- dry, crack, collapse
-
Describe the vinyl plastic tube.
- commonly used, clear
- less porous than rubber, less cracking
- stiffen with age - more flexible at body temp
-
Describe the silicone rubber tube.
- expensive
- smooth, flexible
- non-porous
- less irritating
-
Describe the spiral tube.
- nylon or metal spiral embedded in tube
- very flexible - stylet
- less likely to kink
- very expensive
-
Which tube is mainly used for human medicine?
vinyl plastic tube
-
Which tube is mainly used for veterinary medicine?
silicone rubber tube
-
What is the tip end?
- patient end
- goes into the patient
- beveled - wedge shape, less likely to occlude
-
What is a Murphy hole?
- hole in tip of trach tube
- increases patient safety - give another hole to breathe through just in case the orginial hole gets blocked
- more surface to breathe through
-
What is a Magill tube?
has no hole in it
-
What is the adaptor end?
- machine or circuit end
- stays outside the patient
- connects to anesthetic equipment
-
How are the sizes of tubes determined?
- width (in mm)
- ID (internal diameter)
- written on the side of the tube
-
What are the typical tube sizes for dogs and cats?
-
What is a cuff?
blows up to create an air tight seal between tube and inner linning of trachea
-
What is the purpose of a cuff?
- prevents vomit from getting in the lungs
- anesthetic gas stays in the patient and does not get into the room
- patients won't breathe in room air which will dilute anesthetic gas
-
Do all trach tubes have cuffs?
no
-
Which patients should we avoid using cuffs in?
very small patients and avian patients
-
Is one of the purposes of a cuff is to hold it in place?
no
-
How is the tube held in place?
it is tied
-
What happens if the cuff is blown up too tight?
can cause pressure necrosis (tissue dies)
-
Describe a high pressure cuff.
- thick walled, red rubber
- high pressure over a narrow band in trachea
- damage is possible if it is used for too long
-
Describe a low pressure cuff.
- thin walled, clear plastic
- low pressure over a wide band inside trachea
- less likely to cause pressure necrosis
-
How do you inflate the cuff inflation line?
inject air with syringe
-
What are the different types of cuff inflation lines?
- self-closing
- plug
- clamp shut
-
What is the pilot balloon?
determines how much pressure is in the cuff.
-
What are the advantages to endotracheal intubation?
- open airway
- efficient administration of O2 and anesthetic gases
- assisted breathing
- less room air pollution with waste anesthetic gases
- prevents aspiration
- reduces dead space
-
What is dead space?
air passages inside body where no gas exchange takes place
-
What are the dead spaces?
- mouth
- nasal passages
- pharynx
- larynx
- trachea
- bronchi
- bronchioles
- basically everything but alveoli
-
What are the advantages to reducing dead space?
- increased efficiency
- have to move less gas to get new gas to alveoli
- less effort to breathe
-
What does "increased vagal tone" mean?
parasympathetic stimulation
-
What will happen when there is increased vagal tone?
- bradycardia
- low blood pressure
- cardiac arrhythmias
-
How do we prevent increased vagal tone?
atropine
-
What oral tissues can be damaged with the trach tube?
-
What causes damages to the oral tissues when using placing the trach tube?
- improper positioning
- brachycephalics
- improper size (too big)
-
What are layngospasms?
vocal cords close when they are touched
-
What animal is prone to having laryngospasms?
cats
-
How do we prevent laryngospasms?
- lubricate tube
- apply lidocaine to vocal cords
- place tube during inhalation
-
What is "blind" intubation?
placing tube when unable to see or palpate larynx
-
What are the disadvantages of using a trach tube that is too long?
- passes into 1 bronchus which only will ventilate half of lungs
- unpredictable anesthesia
- increases dead space
- more likely to kink
-
How to we fix a trach tube that is too long?
trim the adaptor end of the tube
-
What can cause a blockage of the trach tube?
- foreign body (blood, saliva, vomit)
- kinked or twisted
- mouth gag
-
What is tracheal mucosa necrosis?
pressure necrosis of lining of trachea
-
What causes tracheal mucosa necrosis?
- cuff too tight
- "dragging" - removing tube without deflating cuff
-
What are the results of tracheal mucosa necrosis?
- cough
- slough
- scar
- stricture (narrowed trachea after healing and makes it difficult to breath or intubate again in the future)
-
What are the improper ways to remove a trach tube?
- removing without deflating cuff
- remove too soon
- not removed soon enough
-
What is cross contamination?
passing pathogens from one patient to the next
-
How do we prevent cross contamination of trach tubes?
- disinfect thoroughly
- discard if it is used with a patient who has a contagious disease
-
Is it easy to accidentally place the trach tube in the esophagus?
yes
-
What happens if you accidentally place the trach tube in the esophagus?
- gastric dilatation
- pressure on lungs
-
What materials are needed to endotracheal intubation?
- anesthesia
- catheterization
- intubation
-
What do we check before using a trach tube?
- inspect tube to make sure it is clean, doesn't have any holes, blockage and to make sure it isn't too worn
- inspect cuff to make sure it is intact and can hold air pressure
- make sure we have the proper length and width for the patient
-
How do we measure the trach tube?
- the tip end should be halfway between the larynx and thoracic inlet (about point of shoulder)
- the adaptor end should be about 1 - 2 cm beyond incisors
-
How do we measure the width of the trach tube?
distance between nostrils
-
What is the intubation procedure?
- lubricate tube
- induce anesthesia
- intubate with patient in sternal recumbency and head slightly stretched out
-
How should the patient be positioned during intubation?
- sternal recumbency
- extend neck, raise head
- open mouth wide, pull out tongue
-
What is the laryngoscope and what is its purpose?
lights up inside mouth so you can see the trachea opening
-
How do we insert the tube?
match curve of tube to curve of neck
-
What is the stylet?
wire - stiffens floppy tube for control of tube tip
-
What do we do with the stylet after we have placed the tube?
remove it
-
Where is the opening of the esophagus?
doral to tracheal opening
-
How do we confirm if we placed the trach tube correctly?
- visualize: see it go in, patient will cough
- palpate neck: can feel the tube if it is in the esophagus
- breathing: feel exhaled breath, see condensation, see bag move
- vocalizing patient: if patient starts to vocalize then tube is not in the right place
-
How do we secure the trach tube?
tie gauze around tube then around muzzle behind canines or around back of the head
-
When do we remove the trach tube?
pull tube when patient starts to lick, chew, swallow
-
Name these tubes.
- clear plastic tube
- red rubber tube
-
What type of tube is this?
spiral tube
-
Which end of the trach tube is this?
tip end (patient end)
-
Which end of the trach tube is this?
adaptor end
-
Are these cuffs deflated or inflated?
deflated
-
Are these cuffs deflated or inflated?
inflated
-
What is this?
cuff inflation line
-
What is this?
inflated pilot balloon
-
What is this?
laryngoscope
-
What are these?
laryngoscope blades
-
Is this the right way or wrong way to put on the laryngoscope blade?
right way
-
Is this the right way or wrong way to put on the laryngoscope blade?
wrong way
-
Is this the right way or wrong way to place the stylet?
right way
-
Is this the right way or wrong way to place the stylet?
wrong way
-
Describe the placement of this trach tube.
perfect
-
Describe the placement of this trach tube.
not far enough in
-
Describe the placement of this trach tube.
too far in
-
Describe the placement of this trach tube.
tube is too long and there is too much out of the mouth...needs to be cut
-
Is this a low pressure or high pressure cuff?
low pressure
-
Is this a low pressure or high pressure cuff?
high pressure
|
|
