Clinical Indications:
- A spontaneously breathing patient in need of intubation (inadequate respiratory effort, evidence of hypoxia or carbon dioxide retention, or need for airway protection).
- Rigidity or clenched teeth prohibiting other airway procedures.
- Patient must be 12 years of age or older or > 55 kg.
Procedure:
- Select the largest and least obstructed nostril and insert a lubricated nasal airway to help dilate the nasal passage.
- Preoxygenate the patient. Lubricate the tube with Lidocaine jelly. The use of a BAAM® device is recommended.
- Remove the nasal airway and gently insert the tube keeping the bevel of the tube toward the septum.
- Continue to pass the tube listening for air movement and looking for “to-and-fro” vapor condensation in the tube. As the tube approaches the larynx, the air movement gets louder.
- Gently and evenly advance the tube through the glottic opening on the inspiration. This facilitates passage of the tube and reduces the incidence of trauma to the vocal cords.
- Upon entering the trachea, the tube may cause the patient to cough, buck, strain, or gag. Do not remove the tube! This is normal, but be prepared to control the cervical spine and the patient, and be alert for vomiting.
- Auscultate for bilaterally equal breath sounds and absence of sounds of the epigastrium.
- Observe for symmetrical chest expansion. The 15mm adapter usually rests close to the nostril with proper positioning.
- Inflate the cuff with 5-10 cc of air.
- Confirm tube placement using waveform capnography.
- Secure the tube to the patient's face.
- Reassess airway and breath sounds after transfer to the stretcher and during transport. These tubes are easily dislodged and require close monitoring and frequent reassessment.
- Document the procedure, time, and result (success) on/with the patient care report (PCR).
- It is required that the airway be monitored continuously through waveform capnography and pulse oximetry.
Certification Requirements:
- Maintain knowledge of the indications, contraindications technique, and possible complications of the procedure. Assessment of this knowledge may be accomplished via quality assurance mechanisms, classroom demonstrations, skills stations or other mechanisms as deemed appropriate by medical control.