Equipment 1 Trach Tube

  1. Define endotracheal intubation.
    passage of a specialized tube through the mouth and into the trachea.
  2. What are the different names for an endotracheal tube?
    • trach tube
    • breathing tube
  3. Should the patient be concious or unconcious when placing the tube?
  4. What does the endotracheal tube bypass?
    dead space
  5. 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)
  6. What are the different types of trach tubes?
    • red rubber tube
    • vinyl plastic tube
    • silicone rubber tube
    • spiral tube
  7. Describe the red rubber tube.
    • cheap
    • common
    • opaque
    • may absorb disinfectant
    • dry, crack, collapse
  8. Describe the vinyl plastic tube.
    • commonly used, clear
    • less porous than rubber, less cracking
    • stiffen with age - more flexible at body temp
  9. Describe the silicone rubber tube.
    • expensive
    • smooth, flexible
    • non-porous
    • less irritating
  10. Describe the spiral tube.
    • nylon or metal spiral embedded in tube
    • very flexible - stylet
    • less likely to kink
    • very expensive
  11. Which tube is mainly used for human medicine?
    vinyl plastic tube
  12. Which tube is mainly used for veterinary medicine?
    silicone rubber tube
  13. What is the tip end?
    • patient end
    • goes into the patient
    • beveled - wedge shape, less likely to occlude
  14. 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
  15. What is a Magill tube?
    has no hole in it
  16. What is the adaptor end?
    • machine or circuit end
    • stays outside the patient
    • connects to anesthetic equipment
  17. How are the sizes of tubes determined?
    • width (in mm)
    • ID (internal diameter)
    • written on the side of the tube
  18. What are the typical tube sizes for dogs and cats?
    • cats: 3.5
    • dogs: 9.0
  19. What is a cuff?
    blows up to create an air tight seal between tube and inner linning of trachea
  20. 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
  21. Do all trach tubes have cuffs?
  22. Which patients should we avoid using cuffs in?
    very small patients and avian patients
  23. Is one of the purposes of a cuff is to hold it in place?
  24. How is the tube held in place?
    it is tied
  25. What happens if the cuff is blown up too tight?
    can cause pressure necrosis (tissue dies)
  26. 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
  27. Describe a low pressure cuff.
    • thin walled, clear plastic
    • low pressure over a wide band inside trachea
    • less likely to cause pressure necrosis
  28. How do you inflate the cuff inflation line?
    inject air with syringe
  29. What are the different types of cuff inflation lines?
    • self-closing
    • plug
    • clamp shut
  30. What is the pilot balloon?
    determines how much pressure is in the cuff.
  31. 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
  32. What is dead space?
    air passages inside body where no gas exchange takes place
  33. What are the dead spaces?
    • mouth
    • nasal passages
    • pharynx
    • larynx
    • trachea
    • bronchi
    • bronchioles
    • basically everything but alveoli
  34. 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
  35. What does "increased vagal tone" mean?
    parasympathetic stimulation
  36. What will happen when there is increased vagal tone?
    • bradycardia
    • low blood pressure
    • cardiac arrhythmias
  37. How do we prevent increased vagal tone?
  38. What oral tissues can be damaged with the trach tube?
    • pharynx
    • larynx
  39. What causes damages to the oral tissues when using placing the trach tube?
    • improper positioning
    • brachycephalics
    • improper size (too big)
  40. What are layngospasms?
    vocal cords close when they are touched
  41. What animal is prone to having laryngospasms?
  42. How do we prevent laryngospasms?
    • lubricate tube
    • apply lidocaine to vocal cords
    • place tube during inhalation
  43. What is "blind" intubation?
    placing tube when unable to see or palpate larynx
  44. 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
  45. How to we fix a trach tube that is too long?
    trim the adaptor end of the tube
  46. What can cause a blockage of the trach tube?
    • foreign body (blood, saliva, vomit)
    • kinked or twisted
    • mouth gag
  47. What is tracheal mucosa necrosis?
    pressure necrosis of lining of trachea
  48. What causes tracheal mucosa necrosis?
    • cuff too tight
    • "dragging" - removing tube without deflating cuff
  49. 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)
  50. What are the improper ways to remove a trach tube?
    • removing without deflating cuff
    • remove too soon
    • not removed soon enough
  51. What is cross contamination?
    passing pathogens from one patient to the next
  52. How do we prevent cross contamination of trach tubes?
    • disinfect thoroughly
    • discard if it is used with a patient who has a contagious disease
  53. Is it easy to accidentally place the trach tube in the esophagus?
  54. What happens if you accidentally place the trach tube in the esophagus?
    • gastric dilatation
    • pressure on lungs
  55. What materials are needed to endotracheal intubation?
    • anesthesia
    • catheterization
    • intubation
  56. 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
  57. 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
  58. How do we measure the width of the trach tube?
    distance between nostrils
  59. What is the intubation procedure?
    • lubricate tube
    • induce anesthesia
    • intubate with patient in sternal recumbency and head slightly stretched out
  60. How should the patient be positioned during intubation?
    • sternal recumbency
    • extend neck, raise head
    • open mouth wide, pull out tongue
  61. What is the laryngoscope and what is its purpose?
    lights up inside mouth so you can see the trachea opening
  62. How do we insert the tube?
    match curve of tube to curve of neck
  63. What is the stylet?
    wire - stiffens floppy tube for control of tube tip
  64. What do we do with the stylet after we have placed the tube?
    remove it
  65. Where is the opening of the esophagus?
    doral to tracheal opening
  66. 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
  67. How do we secure the trach tube?
    tie gauze around tube then around muzzle behind canines or around back of the head
  68. When do we remove the trach tube?
    pull tube when patient starts to lick, chew, swallow
  69. Image Upload 1
    Name these tubes.
    • clear plastic tube
    • red rubber tube
  70. Image Upload 2
    What type of tube is this?
    spiral tube
  71. Image Upload 3
    Which end of the trach tube is this?
    tip end (patient end)
  72. Image Upload 4
    Which end of the trach tube is this?
    adaptor end
  73. Image Upload 5
    Are these cuffs deflated or inflated?
  74. Image Upload 6
    Are these cuffs deflated or inflated?
  75. Image Upload 7
    What is this?
    cuff inflation line
  76. Image Upload 8
    What is this?
    inflated pilot balloon
  77. Image Upload 9
    What is this?
  78. Image Upload 10
    What are these?
    laryngoscope blades
  79. Image Upload 11
    Is this the right way or wrong way to put on the laryngoscope blade?
    right way
  80. Image Upload 12
    Is this the right way or wrong way to put on the laryngoscope blade?
    wrong way
  81. Image Upload 13
    Is this the right way or wrong way to place the stylet?
    right way
  82. Image Upload 14
    Is this the right way or wrong way to place the stylet?
    wrong way
  83. Image Upload 15
    Describe the placement of this trach tube.
  84. Image Upload 16
    Describe the placement of this trach tube.
    not far enough in
  85. Image Upload 17
    Describe the placement of this trach tube.
    too far in
  86. Image Upload 18
    Describe the placement of this trach tube.
    tube is too long and there is too much out of the mouth...needs to be cut
  87. Image Upload 19
    Is this a low pressure or high pressure cuff?
    low pressure
  88. Image Upload 20
    Is this a low pressure or high pressure cuff?
    high pressure
Card Set
Equipment 1 Trach Tube
Clinical Practice