Intubated Patient Management Flashcards
What is the standard adult sizing range for an ETT?
Standard adult ETTs range in size from 6.0 – 10.0mm. Half sizes are also available between sizes 6 – 8mm.
What does the capnogram provide ?
- a visual verification of proper ETT placement
- Validation of EtCO2 value
- Assessment of the patient’s ventilator/breathing circuit integrity and rate to avoid hyper/hypo ventilation
If there were abnormalities shown on the monitor trace, what could this indicate?
Abnormalities in the monitor trace can be indicative of incorrect ETT placement. For example,inadequate cuff seal, oesophageal intubation, airway obstruction, bronchospasm, inadequate
ventilation settings/malfunction 16
where should the tip of the ETT sit?
The ETT tip sits approximately 2cm above the carina
what is the function of the cuff on an ETT or tracheostomy tube?
The ETT cuff provides a seal between the ETT and the tracheal wall to ensure accurate delivery of tidal volumes during mechanical ventilation.
If the ETT cuff is over inflated what are the possible complications that could occur?
Overinflation of the cuff can result in tissue ischemia, ulceration, and necrosis of the tracheal wall
what are the possible complications of an under inflated ETT cuff?
Under-inflation results in the leak of air and oropharyngeal secretions around the ETT cuff, predisposing the patient to inadequate ventilation, de-recruitment, and aspiration pneumonia.
what is a normal cuff pressure and how often should it be checked?
Measure cuff pressure using cuff manometer post-intubation, at the commencement of shift, and/or when cuff leak is suspected. Maintain cuff pressure between 20-30cm H2O as per the solid green section on the cuff manometer
Where and what would you document if your patient was ventilated?
Document all events in the patient integrated notes and ICU CIS Ventilation Observation Chart and the patient integrated notes:
• Date and time of intubation
• Size of ETT inserted
• Position at lips/teeth (NB: If ETT requires adjustment, document time performed and new position)
• ETT cuff pressure (cmH2O)
• Check x-ray performed and position confirmed as satisfactory by MO
• Air entry-auscultation
• Ventilator settings
• Vital signs
• Pharmaceutical agents administered, including dosage
what are the signs and symptoms that indicate a patient may require suctioning?
Signs and symptoms that indicate a patient may need suctioning include:
• Tachypnoea (increased respiratory effort)
• Tidal volume not being delivered
• Cyanosis, redness or pallor
• Newly developed decreased air entry
• Decreasing oxygen saturation levels
• Increased airway pressure (pressure control ventilation) from baseline
• Deteriorating ABGs
• Visible/audible secretions
• Altered chest movement
• Altered haemodynamics, including increased blood pressure and tachycardia
How do you calculate the size of the suction catheter for an ETT?
The size of the suction catheter should occlude no more than ½ of the internal diameter of the ETT
To calculate the catheter size, use the formula:
Size of ETT, minus 2 then times by 2 (e.g. size 8 ETT, - 2 = 6, and then x 2 = size 12F catheter).
What is CSS
Closed System Suctioning
How often should an inline suction be changed?
CSS catheters are routinely changed at 72-hour intervals in accordance with the manufacturer’s recommendations.
NB: Apply sticker with the day of the week the CSS is DUE to be changed – NOT day that CSS is changed
Which suction wall outlet side should the CSS be connected to and why?
CSS remains in situ connected to the left-hand side measured
flow suction wall outlet at all times. This allows the right-hand side suction unit next to the rebreather bag to be used in emergencies and prevents the inline suction from being unnecessarily and intermittently disconnected.
how long can you suction an intubated pt for?
Limit suction pass to 10-15 seconds. Prevents hypoxia.
Catheter passes should be restricted to two unless there are copious secretions. NB: Allow time to ventilate and reoxygenate between suction attempts
