Intubation tube( endotracheal tube): types, sizes, purpose. Set for intubation of the trachea
Unfortunately, from various injuries and diseases no one is immune. In severe cases it is necessary to immediately help a person in trouble. Especially if he has injuries that are life-threatening. These include such urgent conditions as obstruction of the airways, cardiac arrest, shock, coma. Treatment of these pathologies should be carried out in the intensive care unit. Nevertheless, urgent measures must be taken immediately after assessing the patient's condition, that is, in the emergency phase. In the ambulance there is a set for intubation of the trachea, a defibrillator, an Ambu bag. These medical devices are necessary only in severe cases, when a person can not breathe on his own.
What is the use of an endotracheal tube?
Naturally, intubation of the trachea refers to unpleasant procedures. But, despite the inconvenience, it is necessary for life's testimony. To expand the airways and provide oxygen access to the lungs, an endotracheal tube is inserted. The doctor of any specialization should be able to intubate. Especially this skill is necessary for resuscitators and anaesthesiologists, doctors of first aid. Thanks to the introduction of the intubation tube, ventilation of the lungs again becomes normal, despite the damage to the respiratory tract. In addition, using this mechanism, it is possible to carry out an artificial supply of oxygen. There are many varieties of endotracheal tubes( about 20).They differ in size and the presence of an additional mechanism( cuff).All instruments for intubation are divided into 2 types: oro-and nasotracheal tube. Their differences in the ways of penetration to the respiratory organs. In the first case, the intubation tube is inserted through the mouth, in the second - through the nasal passages. In both cases, complications may develop due to organ damage. Therefore, before you choose the route of insertion of the tube, you need to assess the risks. Nevertheless, intubation should be performed, if it is necessary for the life of the body.
Indications for the introduction of the endotracheal tube
In severe conditions, airway patency is possible only by inserting the endotracheal tube into the oral or nasal cavity. In most cases, the patient does not feel painful during the procedure. Since people who require resuscitation are often unconscious. The following indications for intubation of the trachea are distinguished:
- The need for ventilation. Artificial ventilation of the lungs is carried out not only in the ambulance stage, but also in the intensive care unit. This procedure is impossible without intubation of the trachea.
- Need for general anesthesia. In this case, the introduction of an air tube is also mandatory. After all, during general anesthesia, all muscles, including respiratory muscles, are relaxed.
- Exercise of tracheal and bronchial lavage. This procedure is indicated for patients who have mucus, the contents of the stomach in the respiratory tract.
- Improved gas exchange between the lungs and the environment.
It is believed that the endotracheal tube, introduced through the mouth( orotracheal), is indicated in very severe conditions. Among them - stopping respiratory and cardiac activity( clinical death) and coma of any origin. Nasotracheal administration has fewer complications and is considered more physiological. Nevertheless, to prevent acute respiratory failure, doctors often inject the tube through the mouth.
Instruments for intubation of the trachea
The intensive care physician should always have a set for intubation of the trachea. It is stored in a special box with instruments intended for pulmonary ventilation. A set for intubation, if necessary, is taken out from the intensive care unit. This is applicable in those cases when the patient is urgently shown to carry out mechanical ventilation. Medical instruments available in the kit:
- Laryngoscope. This device is represented by two main components - a blade and a handle. It works thanks to a battery or batteries. They are inserted into the handle of a laryngoscope. Blades come in different sizes and shapes( curved and straight).This part is inserted into the oral cavity. At the end of the blade there is a light bulb that illuminates the airways. The choice of the size of a laryngoscope depends on the age of the patient, the condition of the oral cavity.
- Different types of endotracheal tubes. The kit includes tools for intubation of both adults and children. They differ in size, the presence or absence of the cuff, the outer diameter, the length, and also the number of lumens. With the help of these tubes it is possible to carry out both oro-and nasotracheal intubation. Most often for women use air ducts of 7-8 size, for men - 8-10.For the purpose of intubation of adult patients, an endotracheal tube with a cuff is required. To ensure the patency of children's respiratory ways - without it.
- Conductor for giving the intubation tube the right bend.
- Curved tongs.
- Spray of preparations for anesthesia.
Despite the fact that not all tools are used in practice, their availability is necessary in full.
In what cases is the introduction of the intubation tube inadmissible?
Despite the fact that intubation refers to the necessary procedures, it has a number of contraindications. These include: neck injuries, tumors in the oral and nasal cavity, edema of the respiratory tract. In these cases, the introduction of the tube will not be of use, but only contributes to the development of severe complications( tissue rupture, spinal cord injury).Therefore, before proceeding to intubation, it is necessary to examine the oral cavity and nose, pay attention to the condition of the upper spine.
In addition, the introduction of the endotracheal tube may be difficult in some conditions not related to contraindications. Among them: a large tongue, short neck or lower jaw, obesity, significantly protruding front teeth, narrow oral cavity and tracheal anomalies. If the patient has such characteristics, intubation should be carried out with caution. In these cases, preference is given to the introduction of a nasotracheal tube. It should be 1-2 sizes smaller.
Orotracheal intubation is performed as follows:
- The patient is placed on a firm surface, the head is slightly thrown back, and the lower jaw is pushed forward. As a result, the upper incisors are located with airways on the same plane. If possible, a roller is placed under the neck.
- If necessary, clean the oral cavity of vomit, clots, dirt.
- Enter the blade of the laryngoscope( on the right side).It is important not to touch the mucous membrane of the mouth and teeth.
- Next, the intubation tube is inserted. It passes by the mouth and larynx. At the level of the vocal cords, the tube must be carefully passed between them into the tracheal cavity.
- The laryngoscope is removed.
- Inflate the cuff to fix the endotracheal tube.
Nasotracheal intubation is almost the same. Differences are the size of the tube and its introduction into the nasal cavity. In this case, the laryngoscope is not used.
How are the lungs ventilated to children?
There are cases when intubation of the trachea occurs in children. Most often this is necessary when the fetus is deeply premature. Also, intubation is necessary in the period of newborns in detecting the developmental defects of the respiratory and cardiovascular system. In both cases, artificial ventilation is required. Indications for intubation in younger and older children are the same as for adults. Among them: acute respiratory failure, coma, general anesthesia.
What is the depth scale of intubation?
The depth to which the intubation tube is to be inserted depends on the size and weight of the child. To do this, use a special scale. It is applicable to premature and newborn children. At an infant's weight of up to 1 kg, an endotracheal tube of 2.5 is used. The depth of its introduction is counted from the lips and is 6-7 cm. With a body weight of up to 2 kg, the tube size is equal to 3. The insertion depth should be no more than 8 cm. If the child weighs 2 to 4 kg, then the airway size No. 3,5.The depth is thus from 9 to 10 cm. For newborns and infants whose body weight is more than 4 kg, use a tube of 4 sizes. Depth of injection - up to 11 cm.
. What complications may occur after intubation of the trachea?
It is worth remembering that the introduction of the endotracheal tube is dangerous such a complication as damage to the mucous membrane of the internal organs. Therefore, this manipulation should be carried out by an experienced specialist. In the intensive care unit, before an intubation, anesthesia is carried out. The most common complications include: damage to the teeth, mucous membrane of the pharynx, tube entering the esophagus. To avoid this, you must carefully monitor the patient's condition.
Introduction of the endotracheal tube: the opinion of specialists
The technique of intubation is owned by every physician. Nevertheless, reanimatologists and anesthesiologists are best at this manipulation. In their opinion, intubation of the trachea without special preparation and in the absence of sterility conditions is impossible. After all, the complications of this procedure can be irreversible. Nevertheless, the doctor of any specialty is obliged to render first aid for life indications.