ET tube questions

offlabel · Jan 28, 2016

Really not much to say. Make sure it's at an appropriate depth, check lung sounds, confirm it's well secured and make sure it stays there. I will say that my personal practice is disconnecting the circuit from the tube for brief turns or bigger changes in position. Beyond that, just don't let it come out.

JustBeachyNurse, LPN · Jan 28, 2016

Really not much to say. Make sure it's at an appropriate depth, check lung sounds, confirm it's well secured and make sure it stays there. I will say that my personal practice is disconnecting the circuit from the tube for brief turns or bigger changes in position. Beyond that, just don't let it come out.

But a tech/CNA should not be disconnecting vent circuits. Generally auscultating lung sounds is not a CNA/tech skills. There are measurements on the tube. If the connections are taught ask the RN or respiratory therapist before attempting to reposition a patient Moving an ETT a centimeter can displace the tube to the wrong location . If the tube is not secure ask the RN or RT for help before risking harm. Replacement, securing, or adjustment of an ETtube is out of the scope of a nursing student, CNA or tech.

JustBeachyNurse, LPN · Jan 28, 2016

Many RTs are happy to teach if they have the time. In nursing school we even shadowed the RT department for a shift or two to see first hand their specialized skill and knowledge. Maybe your facility can make such arrangements

Thedevinestman · Jan 28, 2016

Thanks guys. I just started in the ICU which is why I asked; I know its a pretty basic question. What I've seen the most of is nurses just adding slack to the vent tubing when turning the patient away from the vent. But I can tell the general consensus is that it should move minimally.

MYSTICOOKIEBEAR · Feb 1, 2016

You can be very liberal with your movement of an intubated patient at long as it is properly secured and there is enough slack on the vent tubing. It is very important to make note of the length at the lips just in case it moves.

Good luck with the rest of your schooling!

emtpbill, ASN, RN, EMT-P · Feb 1, 2016

As a paramedic I have intubated literally hundreds of people. The most challenging are the obese who have no neck and peds.

Preparation is 99% of the battle. Having everything you could conceivably need in hands reach.

I personally am comfortable laying on the ground and intubating people, buts that what the job called for.

Just make sure the once you place the tube you secure it. Commercial tube holders work well. Tape is an alternative but can get messy if the patient vomits. An excellent way of securing a newly intubated patient, for short term , is to put a c-collar on the patient after intubation.

JustBeachyNurse, LPN · Feb 2, 2016

As a paramedic I have intubated literally hundreds of people. The most challenging are the obese who have no neck and peds.
Preparation is 99% of the battle. Having everything you could conceivably need in hands reach.
I personally am comfortable laying on the ground and intubating people, buts that what the job called for.
Just make sure the once you place the tube you secure it. Commercial tube holders work well. Tape is an alternative but can get messy if the patient vomits. An excellent way of securing a newly intubated patient, for short term , is to put a c-collar on the patient after intubation.

OP is a nursing assistant/nursing student. Not likely to intubated anyone in the near future. More asking about nursing assistant care of an intubated patient

offlabel · Feb 2, 2016

But a tech/CNA should not be disconnecting vent circuits. Generally auscultating lung sounds is not a CNA/tech skills. There are measurements on the tube. If the connections are taught ask the RN or respiratory therapist before attempting to reposition a patient Moving an ETT a centimeter can displace the tube to the wrong location . If the tube is not secure ask the RN or RT for help before risking harm. Replacement, securing, or adjustment of an ETtube is out of the scope of a nursing student, CNA or tech.

OP is a second year nursing student that is a nursing assistant in an ICU. Surely the RN's in her unit know this and would be willing to let her listen to breath sounds if she said pretty please? It's not brain surgery. She's asking a good question, which to me implies that she won't take it upon herself to "risk harm" by adjusting the tube or moving a patient on her own. Let the kid learn...sheesh...It sounds like she gets it.

jwk · Feb 2, 2016

Just make sure the once you place the tube you secure it. Commercial tube holders work well. Tape is an alternative but can get messy if the patient vomits. An excellent way of securing a newly intubated patient, for short term , is to put a c-collar on the patient after intubation.

This C-collar thing seems to be a common paramedic thing, but it really doesn't do anything to secure a tube. You will not find a single patient in the ICU or OR with c-collar on to keep a tube from being dislodged. Tape it in properly or use a commercial tube-securing device. When you're moving the patient, best to D/C the circuit, but if you can't do that, make sure the person at the head has one hand on the patient's head and the other holding the tube. Tube's don't just come out on their own - they come out because people are careless.

offlabel · Feb 2, 2016

As a paramedic I have intubated literally hundreds of people. The most challenging are the obese who have no neck and peds.
Preparation is 99% of the battle. Having everything you could conceivably need in hands reach.
I personally am comfortable laying on the ground and intubating people, buts that what the job called for.
Just make sure the once you place the tube you secure it. Commercial tube holders work well. Tape is an alternative but can get messy if the patient vomits. An excellent way of securing a newly intubated patient, for short term , is to put a c-collar on the patient after intubation.

I've intubated literally thousands and thousands and thousands of patients and your advice holds true. Lots of different kinds of providers care for intubated patients, whether they personally placed the tube or not, but all of the same principles apply for not having to replace the tube.

An intact, non soiled tube securing device is critical regardless of what type it is. A stabilized neck and head during movement is critical for maintaining tube position. A plan for emergent mask ventilation and re-intubation with all required supplies and devices within immediate reach is mandatory.

Good post.

Here.I.Stand, BSN, RN · Feb 3, 2016

Thanks guys. I just started in the ICU which is why I asked; I know its a pretty basic question. What I've seen the most of is nurses just adding slack to the vent tubing when turning the patient away from the vent. But I can tell the general consensus is that it should move minimally.

A well secured tube shouldn't move, providing there's enough slack in the circuitry -- hence the RN adding slack before moving the pt. Our RRTs use a holder that tapes to the ckeeks and clips around the tube just outside the mouth. Either the RN or RRT moves the tube laterally q 2 hrs to prevent pressure ulcers on the lip/tongue. The clip stays on the tube but can be slid side to side, and we refasten it after shifting the tube.

I was taught that the teeth are a better landmark than lips, because lips can swell. Teeth remain stationary.

If there is concern about the tube shifting, the RN would call the RRT, check lung sounds, RRT could check and end tidal CO2. If the pt is immediately decompensating, we'd consider calling anesthesia (they do all of the intubations in my unit). Definitive answer about placement can be determined by a stat CXR (which the MD would have to order.)