As the name suggests endo means In, tracheal means into the trachea so that is to say the endotracheal tube is a tube that goes into the patient's trachea, it mainly made of PCV ( polyvinyl chloride) and it can also be made from rubber, silicon & as well as metals.
Sizes of endotracheal tube:- There are different sizes available. Basically, the size of the Endotracheal tube means the diameter of the lumen of the tube which is measured in mm. It ranges from 2.0 to 12.0 with 0.5 mm of increase in each size. i.g- 5.0, 5.5, 6.0, 6.6
Types of Endotracheal Tube:- Orotracheal and nasotracheal tubes are the types of the endotracheal tube, the tracheostomy tube is also an endotracheal tube but we are only going to discuss oro and nasotracheal tube in this chapter.
- Orotracheal tube:- As you can understand by the name "oro" ( mouth/ buccal cavity). This type of tube is inserted into the trachea through the oral cavity. For orotracheal tubes, specialists prefer a large size tube.
- Indication:-
- Unconscious client
- Respiratory failure
- unable to initiate respiration
- cardiac failure
- Any respiratory disease that affects severe lung failure
- Contraindications:-
- severe facial fracture
- Increased intracranial failure
- patient receiving thrombolytic drugs
- Equipment needed in orotracheal tube insertion:-
- Gloves
- Ambu bag
- oxygen source
- orotracheal tube ( in male - 8.0, in female- 7.0 is preferred)
- suction equipment
- Aanesthiatic agents as anesthetics prefer
- Ventilator circuit
2. Nasotracheal tube:- the nasotracheal tube is inserted through the nostrils of the patient. It is used to avoid bleeding disorders and from using this we can avoid tube manipulation by the tongue of the patient.
- Indication:-
- a patient who can't lie due to respiratory distress
- severe asthma
- Trismus ( inadequate ROM of the jaw)
- Contraindication:-
- Epiglottitis
- Anticoagulant therapy
- Nasal polyps
- Equipment needed:-
- Gloves
- oxygen source
- Laryngoscope with blades
- A nasal spray containing vasoconstrictive sustain
- Syring more than 5 ml
- Magil forceps
- Nursing Responsibility in endotracheal tube care
- Nursing care during the procedure
- Collect all equipment at the bedside
- check laryngoscope bulb
- keep ready AMBU bag for stat oxygen delivery
- Assist doctor during the procedure
- Regular monitoring of vital
- Confirm placement of the tube by x-ray. it should be placed at 1-2 cm above the carina.
- Assess the breath sound with the use of the stethoscope ( If the breath sound & chest wall movement are absent on the left side, the tube may be in the right mainstem bronchus)
- Fix the tube with the use of ET tube fixer tape
- monitor the position of the tube at the lip and nose
- Move the oral tube to the opposite site daily to prevent pressure sore and necrosis.
- Done suction regularly to remove mucous substances, if not done ET can be blocked.
- Regular assessment of pilot balloon to detect the inflation of the cuff
- Monitor cuff pressure every 8 hours it should be less than 20 mm of hg. ( An aneroid pressure manometer is used to monitor it)
- Regular monitor vital signs.If any variation than inform HCP ( health care provider)
- Always maintain an aseptic technique.
