This presentation discusses safe extubation of adult patients in the post-anesthesia care unit (PACU). Laryngospasm is the most common cause of post-extubation airway obstruction and can be life-threatening. Registered nurses should not extubate patients who are at high risk, such as those with difficult airway, residual neuromuscular block, or full stomach. Prior to extubation, patients must be awake, following commands, breathing spontaneously, and have adequate oxygen saturation. The 5 steps for safe extubation include suctioning the posterior pharynx, removing tape, deflating the endotracheal tube cuff, extubating at the end of inspiration, and steadily

1. Adult
Extubation
in PACU
A PRESENTATION BY
KIM NESS, B.SC.N., RN 2014

2. Why is safe extubation
important?
Laryngospasm is the most
common cause of post
extubation airway obstruction
and can be life threatening
(Karmarkar, 2008).

3. RNs should not extubate
the following patients

Difficult mask ventilation

Difficult intubation

Residual neuromuscular block
present

4. RNs should not extubate
the following patients...cont’d

Deep anesthetized

Full stomach (i.e. pregnant,
obese, recent ingestion of
food, etc.)

5. Prior to Adult Extubation

VSS, awake

Following commands; unassisted
sustained head lift and strong hand grips

Breathing spontaneously, unlaboured

RR > 12, Spo2 >92 %

Give 100% O2

6. 5 Steps to Extubate
1.
Suction the posterior pharynx

7. 5 Steps to Extubate cont’d
2.
Remove tape
3.
Deflate the endotracheal
tube cuff

8. 5 Steps to Extubate cont’d
4.
Extubate at the end of
inspiration, after deep breath
-glottis is fully opened to prevent
trauma and laryngospasm
5. Pull the endotracheal tube out
steadily

9. Video
http://www.youtube.com/watch?v=IBWwnyP3WKI

10. Post Extubation

Ask the patient to
cough, to clear airway

Apply oxygen

Monitor breathing, SpO2
and vital signs

11. References
Howie, W.O., & Dutton, R. P. (2012). Implementation of an
evidence-based extubation checklist to reduce extubation failure in
patients with trauma: A pilot study. AANA, 80(3), 179-184.
Retrieved from
http://www.aana.com/newsandjournal/Documents/extubationchecklist-0612-p179-184.pdf
Karmarkar, S., & Varshney, S. (2008). Tracheal extubation.
Retrieved January 2, 2014 from
http://ceaccp.oxfordjournals.org/content/8/6/214.extract
Unknown. (2009, November 19) Extubate. Retrieved from
http://www.youtube.com/watch?v=IBWwnyP3WKI