ET Care Management

Alaine de Leon, RN
LCP
Outline of presentation:
Background on ET Intubation
Definition
Indications
Et care management
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Background on Intubation
Endotracheal intubation
is a medical procedure
in which a tube is placed
into the windpipe
(trachea), through the
mouth or nose.
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Indications:
Endotracheal intubation is done to:
Open the airway to give oxygen, medication, or
anesthesia
Remove blockages from the airway
Allow the doctor to get a better view of the upper
airway
Protect the lungs in certain patients

Complications of ET
intubation:
edema; bleeding; tracheal and esophageal perforation;
pneumothorax (collapsed lung); and aspiration.
Subcutaneous emphysema- repeated attempts at blind
advancement of endotracheal tube, created a raw area
on the posterior tracheal wall may have resulted in a
high intrathoracic pressure and disruption of the
injured site. Subsequent high negative intrathoracic
pressure generated might have entrained air along the
sides of the tube through the tracheal rent into the
subcutaneous tissue causing subcutaneous
emphysema



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ET care management
Endotracheal tube
management consists of
ensuring a patent (open
and unblocked) airway,
suctioning pulmonary
and oral secretions, and
providing frequent oral
and/or nasal care.
Preparations:
Any needed supplies for endotracheal tube care should
be at the bedside prior to beginning the procedure.
This includes a sterile suction kit, a bottle of sterile
0.9% sodium chloride, sterile gloves, a clean bite block
if necessary, and tape already torn into appropriately-
sized pieces.
It is recommended that another health care
professional firmly hold the endotracheal tube in place
during any activity that requires loosening the straps
that hold the tube
The patient should also be preoxygenated with 100%
oxygen prior to suctioning.
Procedure:
1. Explain the procedure to the patient.
2. Gather equipment's : disposable clean gloves,
tape/plaster , trache tie, oral antiseptic solution,
cotton balls or gauze, acetone or adhesive remover, bite
block(oral airway), 5 cc or 10 cc disposable syringe,
kidney basin, clean face towel, basin with water soap.
3. Hand hygiene/ wash hands.
4. Position the patient in a lateral position facing you
with head of bed elevated about 30-45 degrees.
Position should facilitate easy removal/replacement of
endotracheal.
5. Suction patient per Orem and per ET prior to
procedure.
6. Don clean gloves and clean around and inside the
mouth using gauze or cotton balls moistened with oral
antiseptic solution, giving attention to the lips, tongue,
making sure patient would not aspire the solution.
7. Remove tie or tape, dispose to appropriate container.
If tape adheres to the skin use adhesive remover.
8. Clean face with wet face towel, soap, rinse and pat
dry using other hand while the other holds the airways
in place.
Procedure:
9. Reposition tube, gently sliding it on the opposite of
the mouth at each change.
10. tape the airway in place, secure further with tie , tie
around the head. Do not anchor tie over the ears to
prevent skin breakdown on the area.
11. Monitor air pressure in the ET. If its >20mmHg,
tracheal necrosis may result. Deflate and re-inflate
cuff according to manufacturers direction.
12. Repeat suction orally and/ET. Check for proper tube
placement .
13. Remove/dispose materials used.
14. Make client comfortable and ensure safety. Raise
side rails.
15. Hand hygiene / Wash hands
16. Documentation procedure and observation.
Procedure
Taping technique protocol
ET ( Endotracheal tube)
a. ADULT (age range)
Technique : 2 Split Chevron Technique
Tape : Silk Tape or Cloth Tape
Size : 1 inch
APPLICATION
a. Prep the ET tube site according to your
facilitys protocol. Let all prep solution dry completely.
b. Cut or tear a 6 inch tape (length)
c. Split tape lengthwise into two sections,
leaving an untorn section of 3 inch. (1 inch)
d. Firmly adhere the untorn portion on the
corner of the mouth where the ET tube is. Apply
rubdown pressure, to maximize adhesion.
e. Place the split tape portion on the upper
lip/lower lip (alternating sites, depending on the
patients oral-skin status). Form a tab at the edge of the
tape.
f. Wrap second strip around tubing- 3 loops.
From a tab at the edge of the tape

Procedure
REMOVAL
a. Last to apply first to remove.
b. Lift the tape from the upper of lower lip,
low and slow considering the hair growth.
c. Using the removed tape, stick it to the
edge of the untorn portion to lift the edge. Remove it
low and slow following the direction of the hair
growth.
d. Remove the tape looped from the tube,
gently.

After care:
All waste should be properly disposed of, either in the
garbage or a biohazard container. The respiratory
status of the patient should be reassessed.
The insertion point (in centimeters) of the
endotracheal tube should be confirmed to be the same
as prior to the procedure, unless the purpose of the
procedure was to change the depth of the tube.
Complications:
The greatest risk of manipulating the endotracheal
tube is that it may be inadvertently removed, causing
the patient to experience respiratory distress.

"Finish each day and be done with it. You have done what you could.
Some blunders and absurdities no doubt crept in; forget them as soon as
you can. Tomorrow is a new day; begin it well and serenely and with too
high a spirit to be cumbered with your old nonsense."
-- Ralph Waldo Emerson
THANK YOU!!!