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Endotracheal Intubation ET Insertion

How to do Endotracheal Intubation

What is the Purpose of Endotracheal Intubation

To maintain patient airway and treat acute respiratory failure, persistent by toxemia and persistent rise in PCO2. Endotracheal intubation (EI) is an emergency procedure that’s often performed on people who are unconscious or who can’t breathe on their own. EI maintains an open airway and helps prevent suffocation.

Scope of Endotracheal Intubation

Patient who suffers CNS depression, neuromuscular disease, Aspiration prophylaxis, upper airway obstruction, etc.

You may need this procedure for one of the following reasons:

  • to open your airways so that you can receive an anesthetic, medication, or oxygen
  • to protect your lungs
  • you’ve stopped breathing or you’re having difficulty breathing
  • you need a machine to help you breathe
  • you have a head injury

Definition – Endotracheal Intubation

Endotracheal intubation is in passing of a slender hollow tube into the trachea through nose or month using aseptic technique to facilitate artificial ventilation and resuscitation.

The trachea, also known as the windpipe, is a tube that carries air to your lungs. It’s about 4 inches long and 1 inch wide. It begins just under your larynx, or voice box, and extends down behind the breastbone, or sternum. Your trachea then divides into two smaller tubes called bronchi. Each tube connects to one of your lungs.

Your trachea is made up of tough cartilage, muscle, and connective tissue. Its lining is composed of smooth tissue. Each time you breathe in, your windpipe gets slightly longer and wider. It returns to its normal size as you breathe out.

Factors that may increase your risk of complications include

  • problems with your lungs, kidneys, or heart
  • a family history of adverse, or bad, reactions to anesthesia
  • sleep apnea
  • obesity
  • allergies to food or medications
  • alcohol use
  • smoking

More serious complications may occur in older adults who have serious medical problems. These complications are rare but may include

  • heart attack
  • lung infection
  • stroke
  • temporary mental confusion
  • death

Requirements / Equipments

  • Disinfectant for Hand Hygiene, Intubation Trolley.
  • Sterile Gloves with mask, sterile towels.
  • Oxygen supply.
  • Suction Apparatus.
  • Ambu bag with face mask.
  • Suction catheters.
  • Endotracheal tubes of various sizes.
  • Oral airway.
  • Steel and Magill Forceps.
  • Laryngoscope with blades.
  • Tongue depressor.
  • Xylocaine Jelly.
  • 10 cc syringe for cuff inflation.
  • Drugs – Sedation, Muscle relaxants, if ordered.
  • Tape, Ties.
  • Catheter Mount.
  • Stethoscope
  • Pulse Oxymeter.
  • ETCO2 probe with module.


  • Explain the procedure to patients and relatives.
  • Ensure regarding obtaining consent.
  • Check equipments availability.
  • To keep ventilator ready.
  • Remove dentures, if present.
  • Positioning of the patient – supine position with neck extended.
  • Administer of 100% O2 to the patient.
  • Administer drugs as ordered.
  • Provide reassurance to the patient throughout the procedure.
  • Observe the patient’s heart rate and O2 saturation throughout the procedure.
  • Lubricate the tube, check the cuff and assist for intubation.
  • Provide cricoid pressure, if required.
  • Once the E.T. tube is in position, inflate the cuff and connect the O2 supply, ventilator is put airway as per size.
  • Suction the patient, E.T. secretion collect and send for culture and sensitivity as per consultant advice.
  • Auscultate lungs for bilateral air entry.
  • Mark the tube at the level of the patient’s mouth and tie the tube securely in position using ties and Dynaplast.
  • Perform Chest X-ray.
  • Position the patient comfortably.
  • Clean the articles used and replace in position.
  • Segregate generated Bio-Medical Waste as per HIC policy.