Tubes and things Part one (airway interventions)

ETT's are mostly made of ___

PVC

ETT's are single patient use. True or false?

true

Most ETT tubes have a _______ faces bevel at the distal tip

Left

why is the distal tip of the ETT beveled to the left?

1. pass easier through the vocal chords

2. Allows for a better view of the ETT tip entering the vocal chords

ETTS can be nasal or oral. True or false?

true

what is the purpose of murphy's eye on an endotracheal tube?

allows for an alternate route for air to pass if the distal tip of the ETT becomes occluded

what is the function of the cuff on an ETT

seal the trachea and seperates the upper airway

uncuffed tubes are usually used in ___________

neonates/infants

Why would a cuff less ETT be used on a neonate ?

because neonates have subglottic narrowing at the cricoid that can create a sufficient seal and avoiding pressure on the tracheal mucosa

ETT have a 15mm _______

outer diameter

ETT sizing refers to ___________

inner diameter in mm

Why is the outer diameter important for ETT

because that is what will be against the airway

what is the purpose of a radiopaque line in an ETT

used for chest x-ray imaging of the tube placement

The length markings on a ETT are in ___ (what unit of measure?

cm

formula for uncuffed ETT sizing for pediatric patients?

age/4 + 4 = ID ETT tube

formula for cuffed ETT sizing for pediatric patient?

age/4 + 3.5 = ID ETT tube

cuff pressure in a endotracheal tube should be less than ______CMH2O which is equal to _______mmHg

25CMH2O which is equal to 18mmHg

what is the significance of the cuff pressure for a endotracheal tube?

it is just below the tracheal capillary pressure

fistula

abnormal passage between two internal spaces

malacia

abnormal softening

stenosis

narrowing

subgottic suction should be _____mmHg

-20mmHg

adult females generally require a ___-____mm ETT

7.0-8.0mm inner diameter

adult males generally require a ___-___mm ETT

8.5-9.5 mm inner diameter

The distal tip of the ETT should be _____ cm from the carina

5cm

ETT cuffs are designed to be ________ pressure ________ volume

low pressure and high volume

a cuff _________ should be used to measure the cuff pressure of an ETT

manometer

the red button on the side of a manometer will __________ the cuff

deflate

cuff pressure above 25cmH2O could ?

collapse capillaries that supply the trachea

not enough pressure in the ETT cuff could cause ?

1. leaking

2. no protection from secretions in the upper airway

what is a major downfall to the minimal leak technique

1. secretions from the upper airway

2. ventilation from the ventilator might be affected

the __________________________________ technique should be used to personalize cuff inflation to each patients needs

Minimal occluding volume technique

why is the minimal occluding volume technique better than the minimal leak technique

Because it prevents a possible aspiration of upper airway secretions and Ventilator abnormalities

possible complications of an ETT

1. teeth, mouth, vocal chords

3. tracheal aspiration of gastric content

4. Esophageal intubations

5. Bronchospasms

6. Hypotension (vagal effect)

7. Tracheal stenosis, fistula, malaria

what type of ETT should be used when tracheal suctioning will be desired through the duration of intubation?

EVAC tube or a CASS tube

what is a CASS ETT

continuous Applied subglottic suctions tube

EVAC tubes can assist in preventing...

VAP -- ventilator-associated pneumonia

subglottic pressure for suctioning via EVAC ETT should be set to ______

-20mmHg

VAP

ventilator associated pneumonia

what are the two black lines near the cuff on an ETT? where should they be?

help in position of the ETTlow black line should be below the vocal chords and upper black line should be above the vocal chords

______________ mouth wash can help prevent bacterial growth in the mouth and VAP

chlorhexidene

the yellow port on an EVAC tube is connected to?

suction

the suction hole on an evac tube is located on the anterior or posterior side of the ETT

posterior side of the ETT

A reinforced ETT is advocated for when there is a concern for

When tracheal compression is a concern

A reinforced ETT has ________ flexibility and _________ collapsibility

more flexibility and less collapsibility

what is special about the tube connector of a reinforced ETT

it is not detachable unlike standard ETT

reinforced ETT are used when more flexibility but less collapsibility is desired such as in

1. fiberoptic intubation

2. intubation through a tracheotomy

3. upper body surgeries (maxillofacial)

4. when a patient requires a prone position

why should a reinforced ETT not be used when a patient needs an MRI?

becuase there is metal inthe Reinforced ETT and it could be pulled out

what is an Endotrol tube

a specialized ETT which has a wire connected to the distal tip which can be pulled on to flex the distal tip anteriorly

when would an Endotrol tube be used ?

used in potential anterior airways

Why would you not use a stylet with an endotrol tube ?

the stylet will stop the anterior flexion of the distal tip

what is an oral RAE tube? when is it used?

A preformed ETT that curves down and away from the patients face. Used when there is facial surgery anticipated or to keep the face sterile for surgery

what is the black line on an oral RAE tube for?

indicates how deep the tube should go and the black line should be at the mouth

what is a nasal RAE tube? when is it used?

a performed nasal ETT the is shaped so it moves up and away from the oral cavity. Used when there is oral surgery antivipated or to keep the oral cavity sterile for surgery

A ETT with metallic wrapping and non-reflective outer. What kind of ETT is this

Laser ETT

what is special about the cuff of a Laser ETT

it is filled with saline mixed with blue dye

The RT examines the patients airway and sees the presence of a blue fluid in the airway, what has happened?

the patient had a Laser ETT and the cuff has been ruptured (it is filled with blue dyed saline)

when is a foam cuffed ETT used?

during air transport when barometric pressure can have an effect on the cuff

the foam cuff should be ________________ while intubating

fully deflated

how does the foam cuff inflate on a foam ETT

by removingthe cap off the cuff's pilot line the foam will automatically re-expand and inflate the cuff

colorimetric Co2 detector

purple represents < _mmHg

tan represents <____-____mmHg

yellow >___mmHg

purple = 3mmHg

tan = 3-15mmHg

yellow = >15mmHg

the ETT cuff pressure should be verified____________

at least every shift or PRN

The Endotrol tube can be used Orally or Nasally. True or false?

True

the foam ETT can be inserted nasally or orally. True or false?

True