Endotracheal tube care Purpose 1 Maintain patent airway

Endotracheal tube care

Purpose: 1. Maintain patent airway and remove secretion. 2. Monitor Cuff pressure. 3. Maintain correct tube placement. 4. Promote ventilation and oxygenation. 5. Provide oral hygiene. 6. Prevent tracheal tube trauma from tube or Cuff. 7. Prevent unintended Extubation. 8. ETT stabilization. 9. Minimize skin breakdown.

Equipment: 1. Tracheal suction equipment 2. Oral care equipment 3. Personal protective equipment 4. Bite block or oral airway if needed 5. Adhesive or twill tape 6. Manual resuscitation bag connected to an oxygen flow meter, at 15 l/min. 7. Stethoscope 8. Cuff manometer 9. syringe

Steps Assessment the patient: 1 - Assess level of consciousness and level of anxiety 2 - Needs for endotracheal tube care including: • Excessive oral or tracheal secretions • Soiled ties or tape • Loose ties or tape • Patient biting or kinking the tube

� Pressure areas on nares, lips , corner of the mouth or tongue � Tube repositioned by physician or other trained personnel

Preparation Patient 3 - Explain procedure to the patient including purpose of ETT care 4 - Assist the patient to a position that is comfortable for the patient and nurse (Semifowler or fowler). Nurse 5 - Wash hands and wear personal protective equipment.

Daily Endotracheal tube care: 6 - Listen the air entry, breath sound air leak at least 2 -4 hours. 7 - Ensure that ETT is connected to the ventilator using a swivel adaptor. 8 -Loosen and remove old tape and ties.

� 9 - Clean around ETT using saline soaked gauze of cotton swabs. � 10 - Perform oral hygiene, using tooth brush and mouth wash. � 11 -Move oral tube to the other side of the mouth. Replace the bite block or oropharyngeal airway along with ETT.

12 - Ensure proper cuff inflation using minimum leak volume or minimum occlusion volume. 13 - Reconfirm tube placement, and note position of tube at teeth or naris. 14 - Secure tube in place with adhesive tape or especially manufactured tube holder.

15 - Hyperoxygenate and suction ETT and pharynx as needed. 16 - Monitor amount, type, and color of secretions. 17 - Monitor for nasal drainage if patient is nasally intubated. 18 - Assess oral cavity and lips and perform oral care every 2 hours.

19 - Retape or secure every 24 hours and as needed for soiled or loose securing devices. 20 - Perform chest physiotherapy.

21 - Report: � Inability to bath suction catheter � Change in quantity or characteristic of secretions. � Purulent drainage � Breakdown � Tube of lips , tongue or oral cavity move in or out of mouth.

22 - Record: �Characteristics of secretion �Presence of nasal drainage �Retaping of ETT �Mouth care �Condition of lips, tongue and mouth

� �Presence � �Amount of cuff leak of air used to inflate cuff � �Centimeter mark on ETT