This document provides information about endotracheal intubation including definition, purpose, equipment used, procedure steps, and confirmation of proper placement. Endotracheal intubation involves passing an endotracheal tube into the trachea through the mouth or nose to secure the airway and facilitate ventilation. Key equipment includes a laryngoscope, endotracheal tubes of varying sizes, and devices to confirm proper placement like end-tidal CO2 detectors. The procedure involves positioning, visualization of the vocal cords, and passing the tube between the cords into the trachea. Placement is then confirmed using physical exam, auscultation, and secondary confirmation with devices.

1. ENDOTRACHEAL INTUBATION
PRESENTED BY : R.PRASANTH
MSC(N) 2ND YEAR

2. DEFINITION
It is a procedure of passing of an
endotracheal tube into trachea
through the nose or mouth.

3. PURPOSE
It is performed to establish and
maintain a patent airway, facilitate
oxygenation and ventilation, reduce
the risk of aspiration, and assist with
the clearance of secretions.

4. INDICATIONS
AND
CONTRAINDICATIONS

5. ADVANTAGES

6. DISADVANTAGES
Need advanced training to properly perform
procedure
Bypasses the nares function of warming and
filtering the air
Increased incidence of trauma due to neck
manipulation when spinal cord injury is
suspected
May increase respiratory resistance
Improper placement

7. EQUIPMENTS

8. LARYNGOSCOPE : handle & blade

9. F Macintosh (curved) and Miller (straight) blade
F Adult : Macintosh blade
F small children : Miller blade
LARYNGOSCOPIC BLADE:
Mc coy blade
Miller blade
Macintosh
blade

10. ENDOTRACHEAL TUBE

11. TYPES OF ETTs:
1) Portex tubes:
Semirigid, with little tendency to kink.
Most commonly used.
2) Rubber tubes:
Soft, easily kinked.
3) Reinforced tubes:
- Cuffed or non cuffed. Reinforced with
wire to prevent kinking.
4) Special tubes:
Double lumen (Robertshaw

12. ENDOTRACHEAL TUBE: (ETT)
Male : ID 8.0 mms
Female : ID 7.5 mms
New born - 3 mths : ID 3.0 mms
3-9 months : ID 3.5 mms
9-18 months : ID 4.0 mms
2- 6 yrs : ID = (Age/3) + 3.5
> 6 yrs : ID = (Age/4) + 4.5
1) Size of ETT : internal diameter (ID)

13. 2) MATERIAL : Red rubber or PVC
3) ETT CUFF
High volume
Low pressure cuff
Low volume
High pressure cuff

14. ETT CUFF
• cuff inflating system consisting of:
• valve, balloon, inflating tube & cuff.
• Uncuffed tubes used in children to minimise pressure
injury
• Purpose of cuff is:
• seal between tube & trachea
• Protect from aspiration of blood, mucus or vomitus.

15. 4) BEVEL
5) MURPHY’S EYE

16. 6) Depth of insertion:
Midtrachea or below vocal cord~2 cm
Adult
Male ~23 cm
Female ~21 cm
Children
Oral ETT = (Age/2) + 12 (cm)
Nasal ETT = (Age/2) + 15 (cm)

17. OTHER EQUIPMENTS:
STYLET
(malleable)

18. FACE MASK & SELF INFLATING
BAG
MAGILL FORCEPS

19. LOCAL ANAESTHETIC
SPRAY

20.  Syringe
 Lubricating jelly
 Dynaplast/ tape to strap
endotracheal tube
 Monitoring success of intubation:
 Stethoscope
 Endtidal - CO2
 Pulse oximeter

21. PREOXYGENATION
PROCEDURE
• ventilate with 100 % oxygen for
approximately 3 min
• Position bed / table height:
bring the patient's head to naval height

22. SNIFFING POSITION
Extension at atlanto-occipital joint
Flexion at lower cervical spine
Neck flexion is maintained by placing a
few
inches of padding behind the head

23. Sniffing
position

24. STEPS OF OROENDOTRACHEAL
INTUBATION

25. BAG MASK VENTILATION
•Thumb and index finger of
left hand in the shape of a
“C” press down
•The other 3 fingers at the
inferior ramus of the
mandible and lift the
mandible up (jaw thrust) “E”
C
E

26. HOLDING A LARYNGOSCOPE
Hold the
handle of
the
laryngoscop
e with your
left hand

27. OPEN MOUTH TECHNIQUES
Hyper-extension technique
(no touch technique)
Cross fingers techniques

28. INTUBATION TECHNIQUE
introduce the blade into the right side of the
patient's mouth
move the blade posteriorly and toward the
midline, sweeping the tongue to the left and
keeping it away from the visual path with
the flange of the blade
ensure the lower lip is not being pinched by
the lower incisors and laryngoscope blade
advance the laryngoscope until the
epiglottis is in view

29. INSERTING THE BLADE

30. INTUBATION TECHNIQUE
lift the laryngoscope upward and forward
insert the ETT from the right angle of mouth
with its concave curve facing downward and
to the right side of the patient
maneuver the endotracheal tube into the
larynx, midway between the cricoid cartilage
and the sternal angle

31. LIFTING UP A LARYNGOSCOPE:
•Pull the blade forward and upward
using firm but Steady pressure without
rotating the wrist
•Avoid leaning on the upper teeth with

32. EXPOSURE OF THE LARYNX:
•In most situations vocal cords should become
visible
• If not, exert gentle pressure over the cricoid
area to help bring them into view

33. BURP Maneuver:
ON THYROID CARTILAGE
•Backward:
•against the cervical
Vertebrae
•Upward
•Right: lateral pressure
to the right

34. HOW TO CONFIRM THE
CORRECT PLACEMENT OF ETT?
Primary Confirmation
Secondary Confirmation

35. PRIMARY CONFIRMATION :
By Physical Exam
Confirm tube placement immediately
Listen over the epigastrium and observe
the chest wall for movement
If stomach gurgling and no chest wall
expansion –
esophagus intubated: deflate the cuff
and remove ET tube
Reattempt intubation after re -oxygenation

36. PRIMARY CONFIRMATION:
CONTD.
If chest wall rises and stomach not gurgling,
perform 5-point auscultation
If still doubt, use laryngoscope to see the tube
passing through the vocal cords (best)
Secure the tube
Look for moisture condensation on the inside
of the tracheal tube
(not 100%: false +ve with esophageal
intubations)

37. SECONDARY CONFIRMATION
End-Tidal CO2 Detectors
Commercial device that reacts with a color
change to CO2 exhaled from the lungs:
Qualitative detection device indicates exhaled
CO2 indicates proper tracheal tube placement
Absence of CO2 (unless prolonged CPR),
indicates esophageal intubation
False +ve: Distended stomach, carbonated
beverages
False - ve: Low or no blood flow states

38. Endotracheal tube(ET) trachea,
endotracheal tube (arrows) and
location of carina (^).

39. AFTER CARE OF THE
PATIENT

40. PROCEDURE FOR
REMOVAL

41. THANK YOU