Which actions should a nurse perform when inserting an oropharyngeal airway? select all that apply.
What is intubation? Learn about the procedures, steps, risks, and requirements for performing intubation. Show
Intubation can mean the difference between life and death. Doctors and nurses perform this procedure on patients who cannot breathe on their own. Patient may need to be intubated when anesthetized during surgery or because of a severe illness that affects their respiratory system. This article focuses on the art and science of intubation, one of the most vital procedures for nurses and other medical staff. Healthcare professionals who master this skill can help save more lives and contribute to higher rates of patient satisfaction. (Click here to see our full list of the most common nursing duties and responsibilities). Intubation is an essential step for surgeries and other lifesaving measures. This important skill can be exciting yet daunting for new healthcare professionals. It’s especially important for Advance Practice Registered Nurses (APRNs), like Nurse Anesthetists, to learn the proper method for intubation in a healthcare environment. Intubation DefinitionWhat Is Intubation?Upon entering the medical field, most aspiring nurses and healthcare professionals quickly learn the importance of proper airway management and, more specifically, the role of intubation in that process. Intubation is a valuable skill that some aspiring nurses should consider learning for their career. It’s also practiced in the field of emergency medical services (EMS). Endotracheal intubation is the process of inserting a tube through the patient’s mouth and into their airway. This is done for patients who need to be placed on a ventilator during anesthesia, sedation, or severe illness. Nasogastric intubation is the insertion of a plastic tube (nasogastric tube or NG tube) through the nose, past the throat, and into the stomach. Nasotracheal intubation is the passing of an endotracheal tube through the naris into the nasopharynx and the trachea. Orogastric intubation is the insertion of a plastic tube (orogastric tube) through the mouth. Orotracheal intubation is a specific type of tracheal tube that is usually inserted through the mouth (orotracheal) or nose (nasotracheal). Fiberoptic intubation is a technique in which a flexible endoscope with a tracheal tube loaded along its length is passed through the glottis. Intubation vs. TracheostomySome people confuse the terms “intubation” and “tracheostomy.” However, these two concepts are different. Intubation is the process of inserting a tube through the mouth and then into the airway. This procedure is done to support a patient’s breathing when placed on a ventilator. Tracheostomy is a medical procedure in which healthcare professionals will create an opening in their patient’s neck to place a tube into their patient’s windpipe. This allows air to enter the lungs. When a trach is placed, the patient may be able to breathe without the aid of a ventilator. Typically, a patient is intubated for the sole purpose of providing oxygen through a machine (i.e. for surgery, sedation, or illness). What Is the Purpose of Intubation?Intubation is a relatively common procedure that’s performed on patients who can’t maintain their airway, patients who can’t breathe without assistance, or a combination of both. Common reasons for intubation:
How Long Does It Take to Perform Intubation?In most cases, intubation can be performed in as little as 30 seconds. If there aren’t any complications, the entire process (from prep to completion) shouldn’t take more than five minutes. Once it’s complete, an overseeing physician will typically check the tube’s placement, listen to the patient’s breathing, monitor their CO2 levels, or take a chest X-ray. Who Performs Intubation?Intubation can be performed by various healthcare professionals, such as physicians, Anesthesiologists, Nurse Anesthetists, and other Advance Practice Registered Nurses (APRNs). (Click here to learn how to become a Nurse Anesthetist). Some EMTs and paramedics may also perform intubation, and in veterinary medicine, the procedure is usually performed by veterinarians or veterinary technicians. Although intubation is not typically performed by most RNs, some states, like Nevada, allow Registered Nurses to intubate patients if they have completed special training (i.e. advanced cardiac life support training). In addition, nurses who work in emergency medicine or air-and-surface transport may also be allowed to intubate patients. Training Requirements for IntubationIntubation requirements can vary and likely depend on your location as well as your profession. It’s important to consult your employer and state governing board. When it comes to intubation training, most licensed professionals such as Anesthesiologists, Nurse Anesthetists, and other Advance Practice Registered Nurses (APRNs) will typically learn how to perform intubation through their advanced nursing and medical training within their respective fields of study. Aspiring APRNs can start this journey by pursing their BSN degree, followed by their master’s degree in nursing. Intubation ProcedureA Detailed Guide to IntubationBy reviewing the following steps, you can begin to learn more about the process of intubation. Like any other skill, intubation requires a lot of time and practice to get it right. While in school, try not to feel disheartened if you don’t get it right the first time. And don’t hesitate to ask for help. Intubation PrepPreparation can greatly vary from one situation to the next. If you’re facing a difficult airway, you will likely perform an “awake intubation.” This is because a detailed airway examination is time-consuming and often not feasible during an emergency. Using a simple 1-2-3 rule for airway examination will allow you to detect potential airway difficulty in a minute or less. When possible, however, psychological preparation is always best for the patient. Do your best to explain the procedure in basic terms. Sedatives can also be used to provide comfort without compromising airway patency. According to NCBI, other types of preparation may include “anaesthetizing the airway through topical application of local anesthetics and appropriate nerve blocks.” Intubation StepsHere are some of the general guidelines you should follow when intubating a patient in a controlled setting:
Nasal IntubationIn some cases, the breathing tube is placed in the nose rather than the mouth. This is called nasal intubation. It’s performed if the mouth or throat has been injured or requires an operation. During this procedure, the nasotracheal tube (NT) goes into the nose, down the back of the throat, and into the upper airway. This type of intubation is far less common, though, as it’s easier to intubate using the larger mouth opening. It also isn’t necessary in most scenarios. Pediatric IntubationWhile the size of the equipment is smaller, the actual process of intubation is often the same for adults and older children. However, it’s important to remember that a child requires a smaller tube than an adult. The procedure will also require a higher degree of precision since their airway is also smaller. Nasal intubation is preferred for neonates and infants. In addition, there are different steps to follow in order to prepare a child for surgery. Intubation RecoveryHealthcare professionals will remove the tube when their patient no longer has trouble breathing on their own. After the procedure, the patient may have a mild sore throat or experience some difficulty swallowing, but this side effect should dissipate quickly. Necessary Equipment for IntubationThe suggested supplies for endotracheal intubation include the following:
Potential Risks or Complications of IntubationWhile this is typically a low-risk procedure, serious intubation risks or complications can include some of the following conditions:
However, the most common reaction to intubation is a mild sore throat or (temporary) minor difficulty when swallowing. You can avoid many of these issues by following the appropriate steps. What they say is true: practice makes perfect. For more professional tips, just keep reading! Pro Tips for Mastering the Art of IntubationMany of our pro intubation tips involve technique, knowing your instruments, and handling difficult-to-intubate cases. Here are a few pro intubation tips from that may assist you in the future.
Why Should Nurses Learn Intubation?In an emergency, it is critical that the patient has adequate oxygen in their blood. The primary goal is to prevent brain damage and sustain life. When the patient is unable to breathe, intubation may be necessary to save their life. Some states allow Registered Nurses to intubate patients for emergency purposes or to administer anesthesia. On the other hand, Advance Practice Registered Nurses have an expanded scope of practice. For instance, intubation is generally included in the scope of practice for a Nurse Anesthetist. Nurse Practitioners are usually permitted to intubate as well. In the nursing field, you never know when you may encounter life-or-death situations. Reflect on your goals and which specialization is best for you. Ensure that you live in a state that suits your needs. And, of course, make sure you pick the right school. Start Your Career in NursingUnitek College offers several nursing programs for aspiring nurses, including our BSN program and Vocational Nursing school. Contact us today to learn more about our programs and tuition assistance options. Take the first step toward a rewarding future in healthcare! |