How to use the endotracheal tube

<p>1. Through the oral cavity</p><p>After exposing the glottis under direct vision with the help of a laryngoscope, the catheter is inserted into the trachea through the mouth.</p><p>(1) Tilt the patient's head back, hold the lower jaw forward and upward with both hands to open the mouth, or use the thumb of the right hand to face the lower dentition and the index finger to the upper dentition to open the mouth by rotating force.</p><p>(2) Hold the laryngoscope handle in the left hand and put the laryngoscope lens into the mouth from the right corner of the mouth, push the tongue to the side and then slowly advance, and the uvula can be seen. Lift the lens vertically until the epiglottis is revealed. Stir up the epiglottis to reveal the glottis.</p><p>(3) If a curved lens cannula is used, place the lens at the junction of the epiglottis and the root of the tongue (epiglottic valley), and lift it forward and upward to make the hyoid epiglottic ligament tense, and the epiglottis will cock up against the laryngeal lens to reveal the glottis. If a straight lens is used for intubation, the epiglottis should be directly provoked and the glottis can be exposed.</p><p>(4) Hold the middle and upper sections of the catheter with the right thumb, index finger and middle finger like holding a pen, and enter the oral cavity from the right corner of the mouth. When the catheter is close to the larynx, move the tube end to the laryngeal lens, while both eyes pass through the lens and the tube. The narrow gap between the walls monitors the forward direction of the catheter and inserts the tip of the catheter into the glottis accurately and lightly. When intubating with the help of a tube core, after the tip of the catheter enters the glottis, the tube core should be pulled out and then the (5) catheter should be inserted into the trachea. The insertion depth of the catheter into the trachea is 4-5cm for adults, and the distance from the tip of the catheter to the incisor is about 18-22cm.</p><p>After the intubation is completed, confirm that the catheter has entered the trachea and then fix it. Confirmation methods are:</p><p>a. When pressing the chest, there is airflow at the catheter port.</p><p>b. During artificial respiration, symmetrical ups and downs of the thorax can be seen on both sides, and clear alveolar breathing sounds can be heard.</p><p>c. When a transparent catheter is used, the wall of the tube is clear when inhaling, and obvious "white fog"-like changes can be seen when exhaling.</p><p>d. If the patient breathes spontaneously, the breathing bag can be seen to expand and contract with breathing after receiving the anesthesia machine.</p><p>e. It is easier to judge if the end-tidal ETCO2 can be monitored, and if the ETCO2 graph is displayed, the correctness can be confirmed.</p><p><br></p><p>2. Transnasal</p><p>Insert the <a href="https://www.hondemedical.com/endotracheal-tube" rel="noopener noreferrer" target="_blank">endotracheal tube</a>&nbsp;into the trachea through the nasal cavity under non-clear vision conditions.</p><p>The spontaneous breathing must be retained during intubation, and the direction of the catheter can be judged according to the strength of the exhaled airflow.</p><p>(1) Use 1% tetracaine as the internal surface anesthesia of the nasal cavity, and instill 3% ephedrine to constrict the blood vessels of the nasal mucosa to increase the volume of the nasal cavity and reduce bleeding.</p><p>(2) Choose a endotracheal tube&nbsp;with a suitable diameter and insert it into the nasal cavity with the right hand tube. During the intubation process, listen to the strength of the exhaled air while moving forward, while adjusting the position of the patient's head with the left hand to find the strongest position of the exhaled air.</p><p>(3) Push the catheter quickly when the glottis is opened. When the catheter enters the glottis, the advancing resistance is reduced, and the exhalation airflow is obvious. Sometimes the patient has a cough reflex. When the anesthesia machine is connected, it can be seen that the breathing bag expands and contracts with the patient (4) breathing, indicating that the catheter is inserted into the trachea.</p><p>(5) If the exhaled airflow disappears after the catheter is advanced, it is a manifestation of insertion into the esophagus. The catheter should be retracted to the nasopharynx, and the head should be slightly tilted so that the tip of the catheter can be tilted upwards, which can be aligned with the glottis to facilitate insertion.</p><p><br></p><p><br></p><p><br></p>