Endotracheal Intubation Tube-Redesigned??

LessValuableNinja · Mar 1, 2015

Your line of questioning is based on the false premise that this is the only method for intubation. I believe you need to do more research. There are a whole lot of different methods, and a whole lot of different types of equpiment.

schnookimz · Mar 1, 2015

So if your new tube tells you that it is placed incorrectly, don't you still need to take it out and place it in correctly??? So what's the difference?

Also, as someone who works in surgery and sees many intubations daily, the crnas and anesthesiologists RARELY miss to be honest. And if they do, it literally takes 2 seconds to remove the tube and replace it. It's not a big deal.

Last thing, hospital won't want to pay for a more expensive tube so you'll have to find a way to make it the same price....

GrannyRRT · Mar 1, 2015

We have focused on the method and device for intubation. Studies have shown prehospital intubation is not always necessary and supra glottic ET tubes can work. At least once the patient is intubated in the ED we can control the type of ET tube for appropriateness and quality. The field tubes often get replaced because of cheap quality and complications. These are important factors to prevent VAE.

The small video scopes are now used in many hospitals, by flight teams and a few ambulances. Facilitating the intubation is better than using a tube which is only good for intubating and little else. We have numerous types of tubes to fit different clinical needs.

If your intubators are missing so many tubes that this is a concern, more training and education would also be more appropriate.

A misplaced tube must be replaced and in the correct place.

overtonis · Mar 1, 2015

you might be better served by contacting respiratory therapist, Critical Care Intensivist or anesthesiologist.

edmia, BSN, RN · Mar 1, 2015

Hi Luis,

It's a good project but I think you need to do more research. The reason tubes need to be taken out has nothing to do with checking for placement. It's more about skill. In hospitals, video guided intubation is more and more common.

Pre-hospital, there are easy to insert tubes that can later be exchanged once patient is in a hospital. Combo-tube is one of them.

There might be a market for this, but you need a lot more research. Talk to CRNAs, respiratory therapists and ask them what they need. Or go to the EMS crews as this is your target population.

Good luck!

Sent from my iPhone -- blame all errors on spellcheck

Altra, BSN, RN · Mar 1, 2015

Hello everyone my name is Luis, and I am currently a graduate student in biology.
My friend, who is a nurse, has mentioned to me that endotracheal intubations (ETIs) are difficult to perform properly the first time and if performed improperly the tube must be removed and another attempt must be made.
He stated that one reason for this procedure being difficult, is that the current methods in assessing correct placement of the tube require one to connect the outer end of the tube to either the EID plunger or the CO2 detectors. Then, to use those devices and determine if the tube is placed properly. And if the tube is determined to be placed improperly, then one must remove the tube completely and retry.
We have brainstormed and concluded that if we made an endotracheal tube (ETT) that has a built in mechanism to assess correct placement of the tube (meaining removing the tube and reattempting are not neccesary), then, presumeably we could eliminate some problems associated with ETIs.
We believe a device like this could be most useful in an out-of-hospital settings as well as military settings.
I would like to get feedback, thoughts, and constructive criticism on our idea.
Thank you all

In what setting does your nurse friend work? This is hugely important to any discussion of intubation, as equipment, meds, and staff/expertise available, as well as the patient's condition and reason for intubation, vary widely.

I have to take exception with the part of your post which I have bolded & italicized, and this is where only superficial second-hand knowledge of the procedure will hinder your investigation of this topic. Of the difficulties faced in the many, many intubations of my patients over the years (I work in ED and ICU settings), I would say that zero had to do with attachment of the CO2 detector. It would be helpful for your knowledge for your nurse friend to elaborate on the problems he has observed with this particular part of the procedure.

It is also incorrect to state that improper tube placement always dictates complete removal of the tube and repeat of the procedure. Tube placement can be and frequently is adjusted by a centimeter or two to achieve optimal placement, without removal of the tube. Categorically stating that the tube has to be removed and insertion reattempted ... sounds like the tube ended up in the esophagus rather than the trachea, and if your friend is observing this frequently, it would seriously call into question the skill of the staff attempting intubation. I don't want to question the clinical competence of healthcare providers without good evidence, so maybe you could clarify this with him.

luisf31 · Mar 1, 2015

Thanks I'll get to it

luisf31 · Mar 1, 2015

Thanks for all the feedback!..

I am investigating all these issues...get back to y'all asap

AnnieOaklyRN, BSN, RN, EMT-P · Mar 8, 2015

If the tube is placed wrong it HAS to come out if it is placed in the esophagus since it is probably bathing in stomach contents coming up the esophagus. If I accidentally intubate the esophagus i leave that tube in in order to contain any stomach contents that may be coming up so that I don't fill the airway with vomit, which would of course makes intubation even more difficult. If the tube is just not deep enough, i.e. it is just above the glottic opening then yes you may keep using the same tube, but see below, there are already multiple devices on the market for this and both target hospital and pre-hospital!

There are also plenty of video based intubation devices out there. On my ambulance we still use direct laryngoscopy, but we can also use what we call a Boogie. It cost a whopping 1.00 if that and if the cords cannot be visualized, the boogie can be used to find the trachea using tactile. The boogie is phenomenal in that even if you have an airway full of crap, despite copious suctioning, you can still find the trachea!

We not longer use, for the most part, either of those devices you mentioned. The bulb was found to be dangerously inaccurate, and in most states it is now required that the EMS agency have continuous end-tidal CO2 monitoring to even perform intubation, thus very few services are even still using those color coded devices anymore.

Also all we have to do is connect the end-tidal, which is attached to our cardiac monitor, and whaaa laaa the tube instantly tells us its in the right, or wrong place! On occasion when I nasally intubate I use this trick to know if my tube is heading in the right place.

I think you may want to come up with another idea, sorry!

Annie

Endotracheal Intubation Tube-Redesigned??

Do you think a ETT like the one we wish to make is needed?