Clinical Indications:
- Longer EMS transport distances or an inability to adequately ventilate a patient with a bag valve mask requires a more advanced airway.
- An unconscious patient without a gag reflex who is apneic or is demonstrating inadequate respiratory effort.
Procedure:
- Prepare position and oxygenate the patient with 100% Oxygen.
- Select proper endotracheal tube (ETT) (and stylet, if used) (No ETT larger than a 7.5), have suction ready.
- Utilize endotracheal tube introducer (Bougie®) according to Airway: Endotracheal Tube Introducer (Bougie®) Procedure.
- Using laryngoscope, visualize vocal cords (use Sellick maneuver/BURP to assist).
- Limit each intubation attempt to 30 seconds with bag valve mask between attempts.
- Visualize tube passing through vocal cords.
- Inflate the cuff with 3-to10 mL of air; secure the tube to the patient’s face.
- Auscultate for bilaterally equal breath sounds and absence of sounds over the epigastrium. If you are unsure of placement, remove tube and ventilate patient with bag valve mask.
- Apply waveform capnography monitor. After 3 ventilations, EtCO2 should be greater than 10 or comparable to pre-intubation values. If less than 10, check for adequate circulation, equipment, and ventilatory rate. If EtCO2 is still less than 10 without physiologic explanation, remove the ETT and ventilate by bag valve mask.
- Consider using a blind insertion airway device if intubation efforts are unsuccessful.
- Document ETT size, time, result (success), and placement location by the centimeter marks at either the patient’s teeth or lips on/with the patient care report (PCR). Document all devices used to confirm initial tube placement. In addition, document positive or negative breath sounds before and after each movement of the patient.
- It is required that the airway be monitored continuously through waveform capnography and pulse oximetry.
Sterile Suctioning Procedure:
Indications:
- Obstruction
- Excessive Secretions
Complicaitons Suctioning May Include:
- Hypoxima
- Cardiac Arrhythmia
- Soft Tissue Trauma
- Infection
- Increasing ICP
Procedure Steps:
- Prexoygenate the patient for 1-2 min
- Maintain universal precautions and a sterile technique
- To measure insertion depth, place the tip of French ("whistle tip") catheter at the corner of the patient's mouth and measure to the angle of the jaw.
- Lubricate the catheter for insertion.
- Insert to premeasured depth (step 3) or until the patient coughs.
- Apply suction only while removing the catheter and remove with a twisting motion.
- Suction for no longer than 10 seconds cardiac monitoring should be observed during tis procedure for dysrhythmia, rinse catheter in sterile water.
- Observe the patient's response to suctioning, and, if need be, repeat this procedure from Step 1.
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.