Endotracheal (ET)Tube Introducer

Preparation before tracheal intubation

 

1. Item preparation

(1) General items: gloves, masks, suction devices, suction tubes, oxygen, lubricants, syringes, stethoscopes;

(2) General equipment: endotracheal tube, catheter core, dental pads and tapes, masks, breathing bags, anesthesia machines and monitors;

 

 

(3) Laryngoscope preparation: Connect the laryngoscope blade to the laryngoscope handle, confirm that the connection is stable, and check the brightness of the light source

 

 

(4) Tracheal tube preparation

1. Tube model selection: Men generally use endotracheal tubes of size 7.5 to 8.5, and women generally use catheters of size 7.0 to 8.0;
2.  
3. The formula for selecting tracheal intubation for children 2 years old and above: tracheal intubation model = (16+age)/4
4. Check whether the catheter balloon is leaking: inject other gas to inflate the balloon and make sure it is intact and has no leaks;
5. Preparation of the stylet: Insert the stylet into the endotracheal tube and shape it. The front end of the stylet should not exceed the bevel of the catheter.
6. Lubrication: Use lubricant to fully lubricate the surface of the tracheal cuff and the front end of the endotracheal tube.

 

(5) Pre-intubation assessment:

Check the patient’s mouth, teeth, mouth opening, neck mobility, and throat conditions to determine whether there is a difficult airway.

 

 

 

 

Procedures for endotracheal intubation

 

1. Posture:

The patient’s occipital area is cushioned with a thin pillow, and the three lines of the mouth, pharynx, and larynx are as consistent as possible;

2. Standing position:

The intubator stands on the side of the head, keeping his eyes at a sufficient distance from the patient to allow direct observation;

3. Oxygen administration:

Use a bag mask "EC method" to provide pressurized oxygen. Inhale pure oxygen for 2 to 3 minutes at a frequency of about 12 times/min.

 

4. Exposure:

Hold the laryngoscope with your left hand, open the patient's mouth with your right hand, send the lens from the right corner of the patient's mouth, gradually move it to the center, push the tongue body to the left, and slowly insert the lens body to the connection between the epiglottis and the base of the tongue. , straighten the left side, lift the laryngoscope forward and upward about 45 degrees, see the edge of the epiglottis, and expose the glottis (presented from multiple angles).

 

 

                  

 

5. Intubation:

Hold the brush-type endotracheal tube in your right hand, insert the tube along the lens from the right corner of the patient's mouth, align the oblique end with the glottis and feed it into the trachea. The cuff enters the trachea, remove the stylet core and continue to insert it. The tip of the catheter is approximately 22 ± 2 cm away from the incisors.
 

The general insertion length for adult women is 17-23CM (the central incisor is the starting point); for adult men, it is generally 19-25cm;

 

The length of catheter inserted in children one year old and above is (cm): age/2+12

 

 

6. Inflate: Inject air into the air bag. When you touch the elasticity of the air bag, it will look like the tip of your nose. Generally, the air bag should be inflated with 5 to 8 mL and no more than 10 mL of gas.

 

 

7. Evaluation: It is visible that there is water vapor on the catheter, which is connected to the simple breathing bag. Artificial ventilation by squeezing the bag shows rise and fall of the chest on both sides, and auscultation of the presence and symmetry of breath sounds in both lungs.

8. Fixation: After confirming that the endotracheal tube has been inserted into the trachea, immediately place the dental pad, then withdraw the laryngoscope, and use tape to fix the tube and the dental pad together. The length of the tape should not exceed the angle of the mandible, and the tape should be firmly adhered and should not stick to the lips.
 

9. Check: Reposition the patient's head, auscultate again to check whether the bilateral breath sounds are symmetrical, aspirate respiratory secretions, and connect the ventilator immediately if necessary.