What Is Nasotracheal Intubation?

Tracheal intubation refers to the technique of placing a special endotracheal tube into the trachea through the glottis, called tracheal intubation. This technique can provide the best conditions for airway patency, ventilation, oxygen supply, aspiration, and prevention of aspiration. .

Tracheal intubation

Tracheal intubation refers to the technique of placing a special endotracheal tube into the trachea through the glottis, called tracheal intubation. This technique can provide the best conditions for airway patency, ventilation, oxygen supply, aspiration, and prevention of aspiration. .

Emergency tracheal intubation technology has become

Emergency tracheal intubation technology has become

Indications for emergency tracheal intubation:

The patient's spontaneous breathing stops suddenly;

Those who cannot meet the needs of the body's ventilation and oxygen supply and need mechanical ventilation;

Those who are unable to clear the upper respiratory tract secretions, gastric contents reflux, or bleeding at any time who have aspirations at any time;

There are upper airway damage, stenosis, obstruction,

Tracheal intubation

Move gently to avoid damaging your teeth. When the glottis is opened, insert the catheter to avoid the top of the catheter and glottis to protect the glottis, the posterior mucosa, and reduce the occurrence of laryngeal edema.

To prevent tooth loss due to suction. Patients should be checked for dentures and loose teeth before surgery, to remove or remove them, so as to avoid injury or inadvertently cause them to fall off, slip into the airway during intubation, cause suffocation and endanger life.

Prevent the air bag from slipping off. If the balloon is secured to the catheter, it will not slip. However, if the catheter is separated from the balloon, a matching balloon should be selected and tied to the catheter with a silk thread to prevent it from slipping into the airway, causing serious consequences.

Check the position of the catheter. After tracheal intubation or mechanical ventilation, bedside X-ray examination should be performed routinely to determine the position of the catheter.

Prevent accidental intubation. During tracheal intubation, especially when the epiglottis is provoked, the reflex of the vagus nerve may cause the patient's breathing,

Oral tracheal intubation is fast and convenient to use. It is more commonly used in rescue of breathing and cardiac arrest. However, oral tracheal intubation is difficult to fix. In the early stage of consciousness recovery in most patients, it can be caused by irritability or intolerance. Remove the pipe early to withdraw. Appropriate sedation or changing the intubation of such patients can ensure timely withdrawal. Nasal tracheal intubation is effective and convenient, can tolerate conscious patients, and is easy to fix, does not affect oral care and eating, and does not cause malnutrition and prolonged use.

Fixation of tracheal tube

The soft-shaped tracheal intubation should be fixed together with the hard tooth pad. It can be double-fixed with adhesive tape and tape to prevent displacement or detachment. The tape should not be too tight to prevent deformation of the lumen. Regularly measure the tracheal intubation and the scale in front of the incisors and record it. At the same time, restrain the hands with a restraint band to prevent the patient from extubation and damaging the throat when he is awake or complicated with mental symptoms. Replace dental pads and tapes daily, and perform oral care.

2. Keep the tracheal tube open

Suction the oral cavity and tracheal secretions in time, pay attention to aseptic operation when sputum suction, mouth, tracheal suction tube must be strictly separated. The suction tube and oxygen suction tube should not exceed 1/2 of the inner diameter of the tracheal tube, so as not to block the airway. Each suction is done one tube at a time, and the suction tube stays in the airway for less than 15 seconds.

3. Keep the airway moist

The concentration of oxygen inhalation should not be too large, generally 1-2 liters / minute is appropriate. The oxygen inhalation needle is inserted into the tracheal tube half. When the sputum is viscous, inhale it every 4 hours, or drip the humidified solution into the trachea, 2-5ml each time, not more than 250ml for 24h.

4. Keep track of the location of the tracheal tube

You can know the position and depth of the catheter by auscultating the breathing sounds of the lungs or X-rays. If the breathing sounds disappear on one side, it may be that the trachea is inserted into the lungs and needs to be adjusted in time.

5. Suitable airbag elasticity

Deflate every 4h for 5-10 minutes, and suck the oropharynx and tracheal secretions before deflating. The tracheostomy should be considered after the tracheal tube is retained for 72 hours to prevent the balloon from compressing the tracheal mucosa for a long time, causing ischemia and necrosis.

6. Extubation procedure

Indications for extubation: The patient is conscious, the vital signs are stable, the cough reflex is restored, the sputum is strong, and the tracheal tube can be pulled out if the muscle tone is good.

Explain to the patient well before extubation and prepare an oxygen mask or nasal cannula.

Aspiration of oral secretions, full suction of sputum in the trachea, and pressurized oxygen with a breathing sac for one minute.

Unfasten the tape and tape of the tracheal tube, place the suction tube at the deepest point of the tracheal tube, suck the sputum while pulling the tube, and immediately give oxygen to the mask after removing the tube.

7. Nursing after extubation:

Observe the clinical manifestations of patients with hypoxia and dyspnea such as nasal fan, shallow breathing, cyanosis of the lip, and accelerated heart rate.

Cut the bag by the bedside gas pipe. Severe throat edema, tracheotomy immediately after inhalation for 20 minutes or 5 mg of dexamethasone infusion, but no relief.