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1. ENDOTRACHEAL
TUBE INTUBATION
By,
MR. ABHIJIT BHOYAR

2. GENERAL OBJECTIVE:
At the end of the topic, students will be able to
acquire more knowledge regarding endotracheal
intubation, develop a positive attitude towards it
and use this knowledge in clinical and teaching
areas.

3. SPECIFIC OBJECTIVES:
At the end of the topic the students will be able to:-
• define endotracheal intubation
• illustrate the purposes of endotracheal intubation
• enlist the articles used for endotracheal intubation

4. Conti…
• demonstrate the procedure of endotracheal
intubation
• enumerate the complications of endotracheal
intubation
• explain the nursing responsibilities of
endotracheal intubation

5. Anatomy

6. •Term Gestation?
•Clear of Meconium?
•Breathing or crying?
•Good Muscle Tone?
Routine Care
•Provide warmth
•Clear Airway if needed
•Dry
•Assess color
•Provide warmth
•Position clear airway
(as necessary)
•Dry, stimulate, reposition
No
Evaluate Resp, HR and
Color
Give Supplementary Oxygen
Breathing, HR>100,
Cyanotic
Observational Care
Breathing, HR>100,
Pink
•Provide positive pressure ventilation 
•Provide positive pressure ventilation 
•Administer Chest Compressions
HR < 60 HR > 60
Apnea HR < 100
 Endotracheal intubation may be
considered at several steps
Post resuscitation
Care
Medications, continue PPV, CC
HR < 60
Pink
Ventilating
HR > 100 & Pink
Persistent cyanosis
Birth

7. DEFINITION
Endotracheal intubation is
the placement of a tube
into the trachea (windpipe)
in order to maintain an
open airway in patients
who are unconscious or
unable to breathe on their
own.

8. INDICATION
• Need for prolonged ventilatory support
• Respiratory arrest
• Respiratory failure
• Airway obstruction
•Hemorrhage with poor perfusion

9. Conti…
• Pulmonary contusion
• Multiple trauma, head injury and
abnormal mental status
• Inhalation injury with edema of
vocal cords

10. Articles required for
intubation
• LARYNGOSCOPE
• AMBU Bag

11. Conti…
• ENDOTRACHEAL
TUBE
• ORAL AIRWAY

12. Conti…
• GLOVES
• ORAL SUCTION
CATHETER

13. Conti…
• Lubricant jelly
• 10ml syringe
• Adhesive Tape
• Stethoscope
• Checked and working ventilator

18. Selection of ET tube
select the largest tube that is appropriate for the patient; this is critically
important to the spontaneously breathing patient who will have to work harder
to overcome the increased resistance

20. Characteristics of Endotracheal
Tubes
2.2cm 2.4cm 2.6cm 2.8cm
Length of Trachea : PT = 3 cm, FT = 5-6cm

21. Size of ET tube
Tube Size
(internal
diameter)
Weight (g) Gestational Age
2.5 <1000 <26
3.0 1000-2000 27-34
3.5 2000-3000 35-40
3.5-4.0 >3000 >38

22. Procedure
STEPS RATIONALE
1. Prepare all the equipments
near the bedside
It saves time, energy and effort.
2. Explain the procedure to the
relatives
To obtain cooperation
3. Take written consent Protect from legal issues

23. STEPS RATIONALE
4. Aspirate stomach contents
prior to procedure
Prevent from aspiration
5. Provide sniffing position to the
child
Provide easy access of
vocal cord and comfort to
the child
Neck
Slightly
Extended

24. STEPS RATIONALE
6. Perform Hand washing To prevent from infection
7. Wear sterile gloves Universal precaution
8. Maintain sterility of
equipment until use
To prevent transmission
of infection
9. Stand at the head end of
the infant
Provide easy access
10. Hold the laryngoscope in
your left hand and stabilize the
infant’s head with right hand
To keep the dominant
hand sterile

25. STEPS RATIONALE
9. Stand at the head end of
the infant
Provide easy access
10. Hold the laryngoscope in
your left hand and stabilize the
infant’s head with right hand
To keep the dominant
hand sterile

26. Before Starting to Intubate

27. STEPS RATIONALE
11. Pass laryngoscope blade
gently along the side of the
mouth
Provide easy access of
vocal cord
12. Gently pull tongue and
epiglottis forward by lifting the
blade
Proper view in epiglottis
and vocal cord

28. Landmarks for Placement
of Laryngoscope

29. Technique to Lift the
Laryngoscope to expose Larynx

30. STEPS RATIONALE
13. Insert ET tube To maintain ventilation
14. Verify the position To prevent from
misplacement of the tube

31. Insertion of ET tube

32. Removing of Stylet

33. Checking of right position
(6 + weight in kg)
Weight (kg)
Depth of insertion
(cm from upper lip)
1 7
2 8
3 9
4 10

34. Check Placement

35. STEPS RATIONALE
15. Apply hydrocolloid
dressing tie
To prevent the
displacemnet of the the
ET tube
16. Replace the articles
and wash hands
Reduces transmission of
micro organism
17. Documentation To protect from legal
issues

36. Complications
• Pharyngeal, oesophageal and tracheal trauma
or perforation
• Cardiorespiratory instability during intubation
attempts
• Accidental extubation
• Blockage of endotracheal tube with secretions

37. • Nosocomial respiratory infection
• Palatal groove formation,
• Acquired cleft palate, and defective primary
dentition
• Acquired subglottic stenosis

38. NURSING RESPONSIBILITY
• Explain procedure
• Ensure standard precautions
• Prepare and check all
equipment
• Prepare infant in a supine
position

39. NURSING RESPONSIBILITY
• Maintain infant warmth
• Ensure continuous monitoring
• Ensure suction equipment
functioning

40. • Assess infant’s tolerance of
intubation attempt
• Aspirate gastric content
• Verify tube position
• Examine chest for bilateral
movement
• Assist with securing the ETT

41. • Connect infant to ventilator
• Ensure chest x-ray
• Check blood gas within 1 hour of
intubation
• Documentation

42. CHECKLIST ON
ENDOTRACHEAL INTUBATION
SR.NO STEPS OF PROCEDURE DONE
NOT
DONE
1.
Prepare all the equipments near the
bedside
2. Explain the procedure to the relatives
3. Ensure standard precautions
4.
Prepare infant in a supine position and
Place infant’s head in the slightly extended
‘sniffing’ position
5. Maintain infant warmth
6.
Ensure continuous monitoring of heart rate
and saturation during procedure.
7. Ensure suction equipment functioning

43. SR.NO STEPS OF PROCEDURE DONE
NOT
DONE
9. Stand at the head end of the infant
10.
Aspirate stomach contents prior to
procedure if the infant has been fed
recently
11.
Hold the laryngoscope in your left hand.
stabilize the infant’s head with right hand
12.
Pass laryngoscope blade gently along the
side of the mouth
13.
Gently pull tongue and epiglottis forward
by lifting the blade
If the infant remains bradycardic for >30
seconds during the procedure remove
tube and ventilate the infant by bag and

44. SR.NO STEPS OF PROCEDURE DONE
NOT
DONE
15. Insert ET tube
16. Verify tube position
17.
Check blood gas within 1 hour of
intubation
18. Apply hydrocolloid dressing tie
19. Documentation
20. Replace the articles

45. CONCLUSION