Assessment This preview shows page 4 - 5 out of 9 pages. 9.How should the therapist determine the depth of insertion of an endotracheal tube markedwith three rings in an infant during the intubation procedure?a.Just when the Murphy eye clears the vocal cords and enters the tracheab.At the location where the second double-ring mark just passes the glottisc.At the point where the first heavy black line just moves beyond the glottisd.Just after the distal third of the tube passes into the trachea past the glottisANS: BThe tip of the ETT is advanced through the glottic opening so that the single black ring is justdistal to the opening of the glottis. If the ETT is marked with three rings, the ETT should beinserted until the double black ring is distal to the glottic opening. REF:p. 22610.How should the therapist confirm proper placement of an endotracheal tube? Get answer to your question and much more REF:p. 22611.Where should the therapist secure a 4.0-mm endotracheal tube after the intubation procedure? Get answer to your question and much more Upload your study docs or become a Course Hero member to access this document We have textbook solutions for you!The document you are viewing contains questions related to this textbook. What is Psychology?: Foundations, Applications, and Integration Pastorino Expert Verified Upload your study docs or become a Course Hero member to access this document End of preview. Want to read all 9 pages? Upload your study docs or become a Course Hero member to access this document Tags REF, stenosis, airway obstruction, Endotracheal tube, LMA We have textbook solutions for you!The document you are viewing contains questions related to this textbook. The document you are viewing contains questions related to this textbook. What is Psychology?: Foundations, Applications, and Integration Pastorino Expert Verified ALERTDon appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions. Refer to the American Heart Association (AHA) interim guidelines for resuscitation of the patient with coronavirus disease 2019 (COVID-19) or a person under investigation (PUI) (Box 1).undefined#ref2">2 In a patient with a suspected spinal cord injury, inline cervical immobilization of the head must be maintained during endotracheal (ET) intubation. Use pulse oximetry during intubation so that oxygen desaturation can be detected quickly. If the saturation is inadequate, stop the attempt and start ventilation by bag mask. Be prepared for a rescue airway to be placed if the intubation attempts fail. Nasotracheal intubation is not recommended in pregnant patients due to the fragility of the nasal mucosa and risk for subsequent bleeding.4 OVERVIEWET intubation is performed to establish and maintain a patent airway, facilitate oxygenation and ventilation, reduce the risk of aspiration, and assist with the clearance of secretions. Indications for ET intubation include:
ET tube size reflects the size of the internal diameter of the tube (Figure 1). Tubes range in size from 2.0 mm for neonates to 10.0 mm for large adults.1 Typically, females require a 7.0- to 8.0-mm tube and males require a 7.5- to 9.5-mm tube with a 15-mm connector.1 The tube should be large enough to facilitate airflow and small enough to pass the vocal cords without damaging them. ET intubation can be done via the nasal or oral routes. The skill of the practitioner performing the intubation and the patient’s clinical condition determine the route used. Nasal intubation is relatively contraindicated in a trauma patient with facial fractures or suspected fractures at the base of the skull, or postoperatively after cranial surgeries, such as a transsphenoidal hypophysectomy. Nasotracheal intubation is also not recommended in pregnant patients because of the fragility of the nasal mucosa and risk for subsequent bleeding.4 For a patient with suspected spinal cord injuries, inline cervical immobilization of the head must be maintained during ET intubation. Improper intubation technique may result in trauma to the teeth, soft tissues of the mouth or nose, vocal cords, and posterior pharynx. Primary and secondary confirmation of ET intubation must be performed.5
ETCO2 monitoring devices have been shown to be reliable indicators of expired carbon dioxide in a patient with perfusing rhythms.5 During cardiac arrest (nonperfusing rhythms), there may not be sufficient expired carbon dioxide due to low pulmonary blood flow.1 If carbon dioxide is detected using an ETCO2 detector, it is a reliable indicator of proper tube placement. If carbon dioxide is not detected, the use of an esophageal detector device or ultrasound performed by an experienced operator is recommended.5 Many methods can be used to secure an ET tube, including tape and commercial devices. The nurse should secure the tube in place immediately after insertion to prevent unplanned extubation. EDUCATION
ASSESSMENT AND PREPARATIONAssessment
Preparation
PROCEDURE
Rationale: A bite block prevents the patient from biting down on the ET tube. Rationale: Securing the ET tube prevents inadvertent dislodgment of the tube.
Rationale: Reevaluating correct tube placement verifies that the tube was not inadvertently repositioned when securing it. Rationale: Recording the position of the tube provides a reference point to assess for possible tube dislodgment in the future. Common tube placement at the teeth is 21 cm for women and 23 cm for men.1 Rationale: Suctioning removes secretions that may obstruct the tube or accumulate on top of the cuff. Rationale: Chest radiographs document actual tube location (distance from the carina). Correct placement is typically 3 to 7 cm (1.2 to 2.8 inches) above the carina.1 The trachea and esophagus overlay each other, so a chest radiograph may not always confirm that the tube is in the trachea and not the esophagus. An ET tube placed bronchoscopically may not require chest radiograph verification (follow the organization’s practice). MONITORING AND CARE
EXPECTED OUTCOMES
UNEXPECTED OUTCOMES
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REFERENCES
Adapted from Wiegand, D.L. (Ed.). (2017). AACN procedure manual for high acuity, progressive, and critical care (7th ed.). St. Louis: Elsevier. AACN Levels of Evidence
Where do you place an endotracheal tube?The optimal placement for the endotracheal tube is 2-3cm above the carina in adults. 3 At the beginning of each ventilator check, watch for equal chest movement and listen for equal breath sounds. 4 If repositioning of the endotracheal tube is warranted, suction the tube and then suction the oropharynx.
What is considered the most reliable way of securing endotracheal tube placement?Capnography provides the most reliable evidence of the placement of the endotracheal tube. It is essential to confirm the correct placement of the endotracheal tube (ETT) promptly after intubation.
How should the therapist determine the depth of insertion of an endotracheal tube for a neonate during the intubation procedure?Determine the appropriate ET tube insertion depth. The tip should be 1 to 2 cm below the vocal cords. For oral intubation, use one of two methods: NTL measurement: The depth of the tube at the gums in centimeters should be equal to the measurement from the nasal septum to the ear tragus plus 1 cm.
How far should the ETT be from the carina?An optimal ETT placement should ensure sufficient distance (2–5 cm) between the tip of the ETT and the carina3 and sufficient distance (1.5–2.5 cm) between the proximal margin of the cuff to the vocal cords.
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