Endotracheal tubes


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Endotracheal tubes

  2. 2. • Endotracheal tubes are curved tubes used for intubation• Tubes were previously made up of latex (indian rubber) and those still available , currently plastic tubes (PVC) are preferred because of following advantages : Disposable (less chances of infection) Hypoallergenic ( since latex allergy is fairly comman) Transparent (easy visualization of blockage ETT due to blood , pus , secretions
  3. 3. • THE ET TUBE HAS THE FOLLOWING COMPONENTS : PROXIMAL END – 15mm adapter (connector) which fits to ventilator or ambu bag CENTRAL PORTION –1. A vocal cord guide (black line ) which should be placed at the level of the opening of the vocal cords so that the tip of the ET tube is positioned above the bifurcation if the trachea.2. A radio-opaque marker which is essential for accurate visualization of the position of the ET tube within the trachea by means of an X-ray
  4. 4. 3. The distance indicator (marked in centimeters) which facilitates placement of ET tube.4. A cuff- incase of cuff ET tube DISTAL END – has Murphy’s eye (opening in the lateral wall ) which prevents complete blockage of ET tube incase the distal end is impacted with secretion , blood , etc.
  5. 5. TYPES• ET tubes can be : - cuffed - uncuffed• Cuffed ET tubes are used in children > 8 years• The cuff when inflated maintains the ET tube in proper position and prevents aspiration of contents from GI tract into respiratory tract• In children < 8 uncuffed ET tubes are used because the narrow subglottic area performs the function of a cuff and prevents the ET tube from slipping.
  6. 6. High volume Low volumeLow pressure cuff High pressure cuff
  7. 7. SIZE• From 2mm to 16 mms (internal diameter ) The size of the tube can be determined by – internal diameter of ETT (mm) = age in years +4 4 Roughly the diameter of the childs little finger is the same as that required for the ETT The following table gives an idea abpout the size of ETT in different age groups.
  8. 8. AGE GROUP SIZE OF ET TUBE PREMATURE BABIES 2 TO 2.5 FULL TERM BABIES UPTO 2 3 TO 3.5 WEEKSFROM 2 WEEKS TO 24 WEEKS 4 TO 4.5 FROM 6 MONTHS TO 12 4.5 TO 5 MONTHSThen increase the size of the ET tube by 0.5cms for every 6 months rise in age so that atapproximately 6 years of age size of the ETtube to be used is approximately 8 mms
  9. 9. USES For Mechanical Ventilation For Intermittent Postive Pressure Ventilation (IPPV) During resuscitation Direct suctioning of trachea in meconium aspiration In Epiglottits &life threatening croup In tetanus (however for long term bases, tracheostomy is preferable) In diptheria In angioneurotic edema
  10. 10. COMPLICATIONS Mechanical trauma to tongue, teeth , palate , pharynx & larynx during intubation procedure Stimulation of posterior of posterior pharyngeal wall leading to coughing , vomiting or vasovagal episode with resultant hypoxia , bradycardia. Prolonged intubation may cause pressure necrosis of laryngeal structures leading to persistant hoarseness ( hence tracheostomy) is indicated in patients requiring long-term mechanical ventilation) Pneumothorax.
  11. 11. AMBU BAG• PARTS OF THE AMBU BAG PATIENT OUTLET (to which mask is attached ) ONE-WAY VALVE UNIT (just proximal to patient outlet ) PRESSURE RELEASE VALVE Attachment site for manometer
  12. 12.  size : the size of the bag varies depending on the volume ( ranges from 250 ml to 750 ml for paediatric use) pressure release valves : are usually set to release at pressure of 30-35cms of water at the end there are two inlets OXYGEN INLET : This inlet is attached to a tube carrying oxygen from the source (central oxygen line or oxygen cylinder ) AIR INLET : if kept open the concentration of 02 is approx 40% FiO2. for the Fi02 to be near 90-100% , and oxygen reservoir should be attached.
  13. 13. MECHANISM OF VENTILATION in the resting stage the ambu bag is filled with air . On squeezing the bag to initiate ventilation the one wave valve proximal to the patients outlet opens resulting in release of air , stored in the bag to the patient. On releasing the pressure the bag gets re-inflated with air. The patients exhaled air cannot re-enter the bag due to one wave mechanism of the valve at the patient outlet.USES : for giving intermittent positive pressure ventilation