medications via ET tube...

[ninnieof02, BSN, RN]

Hello! I am an LPN and a student in a BSN program. I am currently studying pharmacology and have often wondered if I haven't seen MD's shooting meds down someone's ET tube in emergency situations (both in a code I participated in and on my shameful addiction ER). Can anyone clarify if this is a reliable method of administration? It has not mentioned it yet in my pharm studies but I notice in my pharmacokinetics it lists inhalation as being distributed and metabolized in the lungs and excreted through exhaled air ...this couldn't be an effective method of administering ACLS drugs if it never circulates through the circulatory system. Thanks for your help!

Nurse NAN

[ninnieof02, BSN, RN]

I should add: It makes sense to me that the blood rich capillaries covering the alveoli absorb the medication once inhaled although this is contradictory to my pharm info...

[Esme12, ASN, BSN, RN]

There are only certain meds given down ETT tubes and while the are somewhat absorbed it is not an optimal method. The endotracheal (ET) route for drug delivery may be used when a life-threatening or serious condition requires immediate drug intervention, but intravenous or intraosseous access is not readily available. While many medications are absorbed through the endotracheal route, it is uncertain if drug delivery via this route is clinically equivalent to intravenous/intraosseous administration. Blood levels achieved through endotracheal delivery may not be comparable to those produced by IV/IO administration, and optimal doses are unknown. Therefore, endotracheal administration of resuscitation drugs should be considered a second-line intervention utilized only if IV and IO access cannot be established in a timely manner

Endotracheal Drugs

If vascular access is unavailable, the ET route may be used for the administration of certain drugs, including lidocaine, epinephrine, atropine, naloxone, and vasopressin.^2-4

[TABLE=width: 75%]

[TR]

[TD=class: withBorder]Remember the mnemonic NAVEL: ADULTS[/TD]

[TD=class: withBorder]or LEAN (PEDS)[/TD]

[/TR]

[TR]

[TD=class: withBorder]

N

-Naloxone

A

-Atropine

V

-Vasopressin (adults only)

E

-Epinephrine

L

-Lidocaine

[/TD]

[TD=class: withBorder]

L

-Lidocaine

E

-Epinephrine

A

-Atropine

N

-Naloxone

[/TD]

[/TR]

[/TABLE]

Endotracheal administration of medications other than those on this list may damage airway mucosa and is not recommended

CALS Manual

There are drugs that are made for inhalation therapy and that is what they are used for....but in the hospital setting it is rare that we can't get some sort of access device even if it is a IO (intraossessus) so these meds are given the best route for the best outcomes.

[nurseprnRN, BSN, RN]

The drugs are absorbed into the pulmonary capillary bed, and unless there is zero blood flow through that returning to the left heart and then outwards (in which case your patient is dead, so no more worries) it will circulate. With luck, then the ongoing resuscitation efforts will start to pay off and successful IV access will be more useful.