Endotracheal Tube – Surgitech

Description

An endotracheal tube (ET tube) is a medical device used to establish and maintain a patient’s airway during surgery, anesthesia, or in emergency situations when the patient is unable to breathe independently. The tube is inserted through the mouth or nose into the trachea (windpipe) to ensure that air can reach the lungs, and it is often connected to a ventilator to assist with breathing.

Key Features of an Endotracheal Tube:

1. Flexible Tube:
   • The ET tube is typically made of a soft, flexible plastic material (like PVC) to allow for easier insertion and comfort while reducing the risk of trauma to the airway. The tube is designed to be durable yet pliable enough to fit into the patient’s trachea.
2. Cuff (Balloon):
   • Most ET tubes feature an inflatable cuff near the distal (bottom) end. Once the tube is positioned in the trachea, the cuff is inflated to seal off the airway, preventing air leakage and protecting the lungs from aspiration (inhalation of stomach contents or secretions).
3. 15 mm Connector:
   • The proximal (top) end of the ET tube is fitted with a universal 15 mm connector that can be attached to a breathing circuit, ventilator, or manual resuscitator bag (e.g., an Ambu bag). This allows healthcare providers to deliver oxygen and anesthesia gases to the patient.
4. Murphy Eye:
   • The Murphy eye is a secondary opening near the tip of the ET tube. It serves as a safety feature that ensures airflow in case the main opening becomes obstructed by mucus or other materials.
5. Radiopaque Line:
   • Most ET tubes have a radiopaque line embedded along the length of the tube. This line is visible on X-rays, allowing healthcare providers to verify the correct placement of the tube.
6. Depth Markings:
   • The tube is marked with graduated depth markings (in centimeters), which indicate how far the tube has been inserted into the trachea. This helps with accurate placement and monitoring of the tube’s position.
7. Bite Block:
   • Some ET tubes are equipped with a bite block, a rigid structure that prevents the patient from biting down on the tube, which could obstruct airflow or damage the tube.
8. Suction Port (Optional):
   • Some ET tubes come with an integrated suction port, which allows for suctioning of secretions from the airway without removing the tube.

Types of Endotracheal Tubes:

1. Cuffed Endotracheal Tube:
   • This type has an inflatable cuff that seals the trachea, preventing air from escaping and reducing the risk of aspiration. It is typically used for adults or during long-term ventilation.
2. Uncuffed Endotracheal Tube:
   • Uncuffed tubes do not have an inflatable cuff and are often used in pediatric patients since their tracheas are smaller, and a cuff may cause injury.
3. Nasal Endotracheal Tube:
   • This type of tube is inserted through the nose instead of the mouth. It is used in situations where oral intubation is not feasible, such as facial trauma or certain surgeries.
4. Oral Endotracheal Tube:
   • This is the most common type of ET tube and is inserted through the mouth into the trachea.
5. Double-Lumen Endotracheal Tube:
   • This specialized tube has two separate lumens (channels) and is used in procedures that require the lungs to be ventilated independently, such as in thoracic surgery.

Uses of an Endotracheal Tube:

1. Airway Management in Surgery:
   • ET tubes are routinely used during general anesthesia to maintain the airway, ensuring that the patient continues to receive oxygen while under sedation.
2. Mechanical Ventilation:
   • ET tubes are often connected to ventilators in critical care settings to assist or take over the patient’s breathing during severe respiratory failure, chronic lung conditions, or after cardiac arrest.
3. Emergency Airway Control:
   • In emergency situations such as cardiac arrest, respiratory failure, or trauma, ET tubes are used to secure the airway and ensure oxygen can reach the lungs.
4. Prevention of Aspiration:
   • The inflated cuff helps prevent fluids, secretions, or vomit from entering the lungs, making it essential during surgeries or in patients at high risk of aspiration.
5. Respiratory Support in Newborns:
   • In neonatal care, ET tubes are sometimes used to ventilate premature infants or newborns with respiratory distress syndrome.

Procedure for Using an Endotracheal Tube (Intubation):

1. Preparation:
   • The patient is prepped, often sedated, and positioned with the neck slightly extended to facilitate the intubation. The necessary equipment, including the ET tube, laryngoscope, and suction, is prepared.
2. Laryngoscopy:
   • A laryngoscope is used to visualize the vocal cords and guide the ET tube into the trachea. The healthcare provider inserts the ET tube through the mouth (or nose) and into the trachea, ensuring it passes between the vocal cords.
3. Inflating the Cuff:
   • Once the ET tube is in place, the cuff is inflated to secure the tube within the trachea and create an airtight seal.
4. Confirming Placement:
   • Placement of the ET tube is confirmed by listening for breath sounds with a stethoscope, observing chest rise, and using a device like a capnograph to measure exhaled carbon dioxide. An X-ray may also be performed to verify correct positioning.
5. Connecting to Ventilation:
   • The tube is then connected to a ventilator or manual resuscitation bag to begin oxygen delivery and assist with breathing.
6. Monitoring:
   • Throughout the procedure and while the tube is in place, the patient’s vital signs, oxygen levels, and ET tube position are closely monitored.

Risks and Complications:

1. Airway Trauma:
   • Intubation can cause damage to the teeth, vocal cords, or trachea, especially if not done carefully.
2. Infection:
   • Prolonged intubation increases the risk of infection, such as ventilator-associated pneumonia.
3. Misplacement:
   • Incorrect placement of the ET tube in the esophagus instead of the trachea can prevent air from reaching the lungs and requires immediate correction.
4. Aspiration:
   • Improper cuff inflation can lead to aspiration, where fluids enter the lungs, potentially causing infection or respiratory complications.

Conclusion:

An endotracheal tube is a critical tool in airway management, used to provide a clear and secure passage for air to enter the lungs in both routine and emergency situations. Its flexibility, coupled with the ability to form a sealed airway via the cuff, makes it indispensable in surgeries, intensive care, and emergency medicine. By ensuring adequate ventilation and protecting against aspiration, ET tubes play a key role in maintaining respiratory function in patients who are unable to breathe independently.