Step-by-Step Guide to Intubation

Overview

• Intubation is a life-saving medical procedure for patients who cannot breathe on their own.
• Common in surgeries or severe respiratory illnesses.
• Performed by doctors, respiratory therapists, and some nurses.
• Essential skill for healthcare professionals, especially Advanced Practice Registered Nurses (APRNs).

What is Intubation?

• Endotracheal Intubation: Inserting a tube through the mouth into the airway.
• Nasogastric Intubation: Tube through the nose to the stomach.
• Nasotracheal Intubation: Tube through the nose to the trachea.
• Orogastric Intubation: Tube through the mouth.
• Orotracheal Intubation: Tracheal tube usually inserted through the mouth or nose.
• Fiberoptic Intubation: Flexible endoscope with a tracheal tube passed through the glottis.

Intubation vs. Tracheostomy

• Intubation: Tube through the mouth into the airway for ventilator support.
• Tracheostomy: Opening in the neck to place a tube in the windpipe; may allow breathing without a ventilator.

Purpose of Intubation

• Helps patients who cannot maintain their airway or breathe independently.
• Common reasons include general anesthesia, respiratory failure, lung injuries, severe pneumonia, COPD.

Duration

• Intubation can be performed in as little as 30 seconds, typically completed in 5 minutes.

Who Performs Intubation?

• Physicians, respiratory therapists, anesthesiologists, Nurse Anesthetists, APRNs.
• Some EMTs, paramedics, and in vet settings, veterinarians or vet techs.
• RNs in some states with special training.

Training Requirements

• Varies by location and profession.
• Typically learned through advanced nursing and medical training.

Intubation Procedure

Preparation

• Situational; may involve awake intubation in emergencies.
• Psychological preparation and sedatives for comfort.

Steps

1. Sedate patient, position on back.
2. Open mouth, insert tube using laryngoscope.
3. Inflate balloon to secure tube.
4. Verify placement via stethoscope, X-ray.
5. Removal: deflate balloon, gently pull out tube.

Nasal Intubation

• Used if mouth/throat are injured or need surgery.
• Less common due to ease of oral intubation.

Pediatric Intubation

• Smaller equipment, same procedure as adults.
• Nasal intubation preferred for neonates and infants.

Intubation Recovery

• Removal when patient breathes independently.
• Possible sore throat/difficulty swallowing.

Necessary Equipment

• Laryngoscope, endotracheal tube, stylet, syringe, suction catheter, CO2 detector, oral/nasal airway, bag-valve-mask, nasal cannula.

Risks and Complications

• Potential trauma, accidental esophageal intubation, bleeding, aspiration, pneumonia, sore throat, hoarseness.

Pro Tips for Intubation

• Focus on finding the epiglottis.
• Recognize the difference between tongue and esophagus.
• Use correct blade technique and confirm trachea placement with capnography.

Why Nurses Should Learn Intubation

• Critical for emergency oxygenation.
• Allows for broader practice scope for APRNs.

Career in Nursing

• Unitek College offers various nursing programs.
• Opportunities for specialization and advanced study.