Nurses play a key role in the care and treatment of patients and perform a number of key roles and duties within the hospital that are vital to patient safety – including intubation.
We took a closer look at the details of this important skill set to find out more about what nurses can do when it comes to intubating patients.
What Is Intubation?
Intubation refers to the process of inserting an endotracheal tube (ETT) into the trachea through the mouth or nose of a patient.
This allows for air to be delivered directly to the lungs via the ETT, which helps to maintain oxygen levels in the blood. The procedure also prevents aspiration of stomach contents into the lungs, which may lead to pneumonia.
Who Can Perform Intubation?
Intubation requires certain skills and training from both the nurse and the patient.
A registered nurse with appropriate education and training should be able to perform intubation on any adult patient who has been determined by a physician to have difficulty breathing. In addition, the patient must be awake and alert during the procedure (see also ‘How To Find Brachial Pulse‘).
Can Nurses Intubate Patients?
Intubation can be carried out by nurses, but It requires special training and experience. A nurse must first learn how to insert an ETT correctly. They should also understand the risks involved with intubating patients.
The nurse must then practice intubation on mannequins until they feel comfortable doing so. Once the nurse feels confident, it will be time to practice and perform intubation on real patients.
Why Is Intubation Used?
There are many reasons why intubation is used in medical settings. It is often performed to assist in maintaining oxygen levels in the body, prevent aspiration of gastric contents into the lungs, and provide mechanical ventilation support.
Mechanical Ventilation Support
When a patient needs to breathe on his or her own but is too weak to do so, a ventilator provides assistance. Mechanical ventilation can help patients recover from illnesses such as heart failure, lung disease, and brain damage.
Preventing Aspiration
Aspiration occurs when food or liquid enters the lungs instead of being swallowed. Patients who have difficulty swallowing may develop this problem. Aspiration can cause serious complications including pneumonia, bronchitis, and even death.
Maintaining Oxygen Levels
When a patient receives supplemental oxygen through an endotracheal tube (ETT), it helps maintain adequate oxygen levels in the blood. The amount of oxygen provided depends on how much oxygen is needed by the patient.
Assisting With Breathing
If a patient is having trouble breathing, he or she may benefit from assisted ventilation. This involves placing a tube down the throat and into the trachea, which connects the lungs to the rest of the body.
Can All Patients Be Intubated?
The following individuals may not be suitable to receive intubation:
- Patients who are unconscious due to head injury, stroke, drug overdose, or other causes
- Patients who are known to have bleeding disorders or conditions that would make them bleed excessively if they were to receive a laceration
- Patients who have had recent surgery and have been advised to avoid intubation
- Patients who cannot protect their airway because of foreign bodies such as dentures, braces, or neck injuries
- Patients who require sedatives or paralytics
- Children under 2 years old
- Patients who weigh less than 40 kg
- Patients who suffer from severe respiratory distress;
- Patients who exhibit signs of impending cardiac arrest
- Patients who have suffered trauma to the chest wall
- Patients whose condition is unstable
- Patients who are unable to protect their airway
How Do I Prepare My Patient For An Intubation?
Before performing intubation, you will need to prepare your patient for the procedure (see also our article on the procedure of opening an ampule) . You will want to ensure that the patient’s airways are clear of secretions and debris before attempting to place the ETT.
If possible, you should wait until the patient has received fluids and medications prior to beginning the procedure (see also ‘How To Remove NG Tube‘).
You will also want to check the patient’s pulse oximetry readings to determine whether they are receiving enough oxygen, and if the patient is conscious, you will want to ask them questions to assess their level of understanding and ability to cooperate with the procedure (see also our article on administering vaccines).
What Are Some Complications Associated With Intubation?
Complications associated with intubation include:
Infection
Infection is one of the most common complications associated with intubation. When bacteria enter the bloodstream via the mouth, nose, or eyes, an infection can occur.
Airway Obstruction
A blockage in the airway can result in a lack of oxygen reaching the lungs. This complication can be caused by swelling around the vocal cords or tongue, bleeding, or other problems.
Bleeding
Blood loss can occur during intubation. This can lead to shock, low blood pressure, and death.
Cardiac Arrest
Cardiac arrest can occur when the electrical activity of the heart stops. This usually happens because of a sudden drop in blood flow to the brain.
Hypoxia
Hypoxia is a condition where there is not enough oxygen in the blood. This can happen when the lungs fill up with fluid or become blocked.
Death
Death can occur when the respiratory system fails due to any number of causes.
How Can I Prevent These Problems From Occurring?
Before performing intubation, make sure that your equipment is ready for use. Make sure that all necessary supplies are available, and that you know what medications are required before starting the procedure (see also ‘How To Measure For NG Tube‘).
Make sure that the patient has been given sufficient time to prepare for the procedure (see also our guide to removing a central line). If possible, allow the patient to sleep overnight prior to intubation.
Be aware of the signs of hypoxia and hypercarbia. Hypoxia can be detected by observing the color of the lips and fingernails. Hypercarbia can be detected by checking the skin’s temperature.
Be careful about using drugs that affect respiration. Sedatives and muscle relaxants can slow the rate at which oxygen reaches the lungs.
Final Thoughts
Intubation is an important part of caring for patients and is a practice that requires skill and experience on the part of the healthcare provider.
The best way to prevent complications from occurring is to practice intubation regularly so that you gain proficiency with the technique.