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.
Purpose
The endotracheal tube is the most common artificial airway used for short-term airway management or mechanical ventilation. The tube may be inserted either orally or nasally. The patient with a endotracheal tube must be closely monitored to ensure that the tube remains patent, that skin breakdown does not occur from the tube, and that infection is prevented.
Precautions
If the patient is restless or agitated, any activities that involve loosening the straps that hold the endotracheal tube in place should be rescheduled for a time when the patient is calm or after a sedative has been given. Otherwise, the tube may be inadvertently removed and the airway lost.
Description
A primary portion of endotracheal tube management is suctioning down the tube every two hours or as needed. This is a sterile procedure. The color and amount of any sputum return should be noted since the endotracheal tube provides a direct connection to the lungs, making these patients highly susceptible to infection. The oral cavity should also be suctioned as these patients often have difficulty swallowing saliva.
The patient must also be monitored for skin breakdown in either the oral or nasal cavity (depending on where the tube is inserted). Thorough oral care should be provided every eight hours and as needed. If the patient has a bite block to prevent them from biting the tube, it must be removed and cleaned or replaced every eight hours. The tube should be repositioned so that it is not continuously exerting pressure in the same area. If the tube is taped to the patient's face, the tape must be removed and replaced on the opposite side of the face at least once per day and as needed.
The endotracheal tube has a cuff that is inflated with air to hold the tube in place in the trachea. The amount of air in the cuff should be checked every eight hours to ensure that the cuff is not exerting too much pressure on the trachea walls. This is often done by the respiratory therapist, but may also be done by the nurse.
Preparation
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.
Aftercare
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.
Results
The anticipated outcomes of endotracheal tube management include a continuously patent airway, control of oral and pulmonary secretions, and prevention of infection.
Health care team roles
The nurse and respiratory therapist are equally responsible for endotracheal tube management. Both perform sterile suctioning and both are responsible for assessing respiratory status. However, it is usually the nurse who repositions the tube and provides oral care.
KEY TERMS
Bite block—Plastic device inserted into the patient's mouth to prevent him/her from biting on the endotracheal tube.
Endotracheal tube—Flexible tube inserted into the trachea via either the oral or nasal cavity for the purpose of providing an airway and supplemental oxygen, as well as providing access for suctioning.
BOOKS
"Providing Endotracheal Tube Care." In Critical Care Skills: A Nurse's Photo Guide, edited by June Norris. Springhouse, PA: Springhouse Corporation, 1996, pp. 280-293.
Thelan, Lynne, et al. Critical Care Nursing: Diagnosis and Management. St. Louis, MO: Mosby, 1998.
