qì guǎn nèi chā guǎn
2 English referenceendotracheal tube
ET
ETT
3 Operation nameendotracheal tube
4 Indications
Endotracheal tube is indicated for:
(1) cardiac arrest.
(2) Respiratory failure aggravated by medication.
(3) Ventilation disorders caused by various reasons, such as upper respiratory tract obstruction, sputum weakness, short-term need for continuous removal of airway secretions, drug intoxication, endotracheal tumors, myasthenia gravis, multiple rib fractures.
(4) Longer general anesthesia or major surgery with muscle relaxants.
5 ContraindicationsAcute pharyngitis, tracheal submucosal hematoma, aortic aneurysm compression or invasion of the trachea, hemorrhagic qualities or a tendency to hemorrhage is a contraindication to endotracheal intubation.
6 PreparationPreparation of instruments:
1. Laryngoscope? Anesthesia laryngoscope lenses curved and straight, each with three different specifications for adults, pediatrics and infants to choose from, generally curved more often used.
2. Tracheal tube? Most of the rubber or plastic tubes, according to the patient's age, gender, body type and so on to choose a different length and thickness of the catheter. Adult males are usually 36-40, women 32-36; pediatric number is often: 1-7 years: age +19; 7-10 years: age +18; 10-14 years: age +16.
3. Attached to the outer wall of the anterior end of the catheter leakage prevention device, the choice of low-pressure or isobaric airbag can reduce the pressure on the mucosa of the trachea, 6 years of age or less should not be used in general.
4. Others? Intubation forceps, dental pads, 1% bupivacaine surface anesthesia spray, catheter core (copper or aluminum wire), catheter lubricant, suction device, oxygenation device and so on.
7 endotracheal intubationcan be oral or nasal two kinds of operation, the former is often in the clear vision of the operation quickly, mostly used in the rescue of cardiac arrest; and the latter is often used in the consciousness of light obstacles, difficult to open the mouth and the artificial airway needs to be retained for a few days; tracheotomy is generally used for a longer period of time to maintain the artificial airway.
Three endotracheal intubation procedures are commonly used:
(1) Transoral visual intubation: ① The patient is lying on his back, with his head tilted back as far as possible, and the oral cavity is checked for denture and loose teeth. If the larynx is not well exposed, you can put a thin pillow under the back of the shoulder. ② The left hand holds the laryngoscope handle, the right thumb pushes open the patient's lower lip, with the laryngeal lens will be pushed to the left side of the tongue, along the back of the tongue to the pharynx slowly into the first exposure of the uvula, and then expose the epiglottis. ③ The anterior end of the laryngeal lens is placed in front of the epiglottis cartilage and lifted upward to expose the vocal folds. After seeing the vocal folds, the tracheal tube is gently inserted into the vocal folds at a depth of 3 to 5 cm beyond the vocal folds, as it is easy for the tube to slip out if it is too shallow, and easy to be inserted into one side of the main bronchus if it is too deep. If the vocal folds are not visible, the catheter can be inserted in the direction of the center of the epiglottis margin to explore the vocal folds. ⑤ Place a dental pad and secure the catheter with adhesive tape. ⑥ Inject the sleeve with air (about 3-5 ml). The amount of air injected should not be too much, so that the airbag just closes the trachea without leakage. (7) Chest auscultation to determine the position and depth of the catheter, such as one side of the respiratory tone decrease suggests that the catheter is inserted too deep.
(2) transnasal blind intubation: ① before intubation with ephedrine drops in the nose several times, and then drop a little liquid paraffin oil, awake patients should be done in the posterior wall of the pharynx 1% bupivacaine spray surface anesthesia. ② the right hand holding the catheter inserted in the direction of the nasal cavity, out of the posterior nostril, the left hand to support the patient's occiput and change the head and neck of the forward or backward angle, the right hand to adjust the position of the catheter mouth, to find the strongest part of the catheter airflow ringing. ③ Deepen the catheter when the patient inhales or exhales, the resistance to propulsion of the catheter decreases after entering the trachea, and the breath sounds in the tube are clear. During the insertion process, it is forbidden to use violence to advance. If the head bends forward too much, often mistakenly into the esophagus, although there is a feeling of resistance reduction, but there is no breath sound in the tube; such as the head is too tilted back and easy to make the catheter against the epiglottis and the root of the tongue between the propulsion resistance increases. If one side of the nostril repeatedly tried ineffective, can change another nostril.
(3) Transnasal visual intubation: the endotracheal tube is inserted into the posterior nostril with the same operation as the transnasal blind probing method, and the subsequent steps are the same as those of transoral intubation.
8 Precautions(1) Before intubation, check whether the intubation equipment is complete and suitable, especially whether the laryngoscope is bright.
(2) When tracheal intubation, the patient should be in a moderate or deep coma, and the pharyngeal reflexes should be absent or slow; if the patient is drowsy or in a light coma and the pharyngeal reflexes are sensitive, surface anesthesia of the pharynx should be performed, and then intubation should be performed.
(3) The laryngoscope should always be placed on the tip of the laryngeal lens and the method of lifting the laryngoscope should be used. When it is difficult to reveal the vocal folds, you can ask the assistant to press the laryngeal node, which may help to reveal the vocal folds, or use the catheter core to bend the catheter into an "L" shape, and pick up the epiglottis with the front end of the catheter, and then perform blind intubation. If necessary, a transnasal intubation, retrograde catheter-guided intubation, or fiberoptic bronchoscope-guided intubation can be performed.
(4) Intubation action should be gentle, rapid and accurate operation, do not make the hypoxia time too long, so as not to cause reflex cardiac arrest, respiratory arrest.
(5) After intubation, sputum suction, must be strictly aseptic operation, sputum suction duration should not be more than 30s at a time, if necessary, in the oxygen after suction again. Inhaled gas through the catheter must pay attention to the wetting, to prevent the secretion of the trachea thick crust, affecting the smooth airway.