What is an Endotracheal Tube?
An endotracheal tube, commonly referred to as an ETT or tracheal tube, is a thin, flexible plastic tube that is inserted through the mouth or nose down into the trachea (windpipe). Its main purpose is to maintain an open airway and allow a patient to breathe when they are unable to do so unaided. This article will delve deeper into what endotracheal tubes are used for, how they work, and some important aspects about their use and care.
Uses of Endotracheal Tubes
Endotracheal
Intubation, which involves inserting an ETT, is often required during
surgery when a patient needs to be put under general anesthesia. This is
because under anesthesia the muscles of the throat relax and can collapse,
obstructing the airway. Therefore, securing an artificial airway with an ETT is
necessary to allow breathing while the person is unconscious.
ETTs are also commonly used in emergency situations when a person is unable to
maintain their own airway, such as during cardiac arrest, major trauma, severe
breathing difficulties, or drug overdoses. By establishing a clear pathway into
the lungs, the ETT helps provide oxygen and allows ventilation by bag-mask or
mechanical ventilator.
For patients with respiratory conditions such as COVID-19, ETTs may be
necessary to apply Positive End-Expiratory Pressure (PEEP) therapy or to
connect the patient to an Extracorporeal Membrane Oxygenation (ECMO) machine,
both of which can help improve oxygen levels in the blood. ETTs are also useful
for laryngoscopy procedures that require examination or treatment within the
vocal cords and trachea.
Components and Placement of Endotracheal Tubes
An ETT typically consists of a safely flexible tube made of polyvinyl chloride
(PVC) plastic, with an inflatable cuff or balloon at its distal tip. The
proximal end has a standard 15mm connector to attach to a ventilator circuit,
anesthesia machine or bag-mask resuscitator.
To insert an ETT, the vocal cords are visualized using a laryngoscope, which
holds the tongue out of the way. The tip of the lubricated ETT is then gently
guided between the vocal cords and advanced downward a proper predetermined
distance into the trachea. Correct placement in the mid-trachea is confirmed
using methods like observation of condensation in the tube, chest rise with
ventilation, auscultation of breath sounds and capnography monitoring of
exhaled carbon dioxide.
Once situated, the cuff at the distal end is inflated with air using a syringe
to form a tight seal within the trachea. This sealing function of the cuff is
crucial, as it helps prevent air from leaking up and around the ETT instead of
entering the lungs during ventilation. It also prevents stomach contents and
secretions from entering the trachea and lungs.
Nursing Care of Endotracheal Tubes
Optimal care and maintenance of ETTs is important to promote patient safety and
comfort. Some key nursing interventions involve:
- Securing the ETT with tape or a commercial securing device to prevent
accidental dislodgment.
- Inflating the cuff with the minimum volume of air needed to form an effective
seal and prevent excess pressure on tracheal walls.
- Suctioning secretions above and below the cuff as needed to keep the airway
clear.
- Repositioning the patient as able and performing oral hygiene regularly to
prevent pressure sores around the mouth.
- Monitoring cuff pressure using a manometer and inflating if needed to
maintain an adequate seal without injury.
- Checking placement and ensuring proper ventilation and breath sounds
periodically.
- Documenting details of ETT care like cuff pressure, positioning changes and
suctioning thoroughly.
- Involving speech therapy as indicated to prevent laryngeal injury from
intubation.
Potential Complications of Endotracheal
Tubes
While ETTs are life-saving devices, their use does carry some risks if not
carefully managed. Potential complications can include:
- Aspiration: If the cuff leaks or is not properly inflated, stomach contents
can be inhaled into the lungs causing infection.
- Tracheal injury: Over-inflating the cuff can damage the tracheal mucosa,
potentially leading to stenosis over time. Improper technique during intubation
also poses trauma risks.
- Ventilator-associated pneumonia: Pneumonia risk increases the longer someone
requires ventilation, as saliva and secretions can pool above the cuff.
- Accidental dislodgment: If accidental extubation occurs, the airway may need
to be resecured emergently.
- Laryngeal injury: Prolonged intubation can cause laryngeal nerve damage,
vocal cord injury or laryngeal edema on extubation.
Close monitoring and following best practices for ETT care help reduce risks. Overall,
with proper usage, ETTs serve as an invaluable medical advancement for airway
management in numerous critical care situations. Further research continuously
improves their safety profile as well.
Endotracheal tubes are vital medical devices that help facilitate breathing and
oxygenation in patients who cannot maintain their own airway. From intubation
technique and tube positioning to ongoing nursing care and potential risks,
this article aimed to provide thorough insight into endotracheal intubation
procedures and management of ETTs. Their applications significantly benefit
patients in emergencies, surgery and respiratory distress. With standardized
best practices, ETTs save lives on a daily basis worldwide.
Comments
Post a Comment