Types of intubation

Endoctracheal intubation-  the passage of a tube through the nose or mouth into the trachea for maintenance of the airway during anesthesia or for maintenance of an imperiled airway.  This is considered a relatively temporary procedure. The type of intubation used depends on the patient’s condition and on the purpose for intubation.

 Nasogastric intubation- the insertion of an endotracheal tube through the nose and into the          stomach to relieve excess air from the stomach or to instill nutrients or medications..  

Nasotracheal intubation- (blind) the insertion of an endotracheal tube through the nose and into the             trachea. The tube is passed  without using a laryngoscope to view the glottic opening.  This technique may be used without hyperextension, therefore it is useful when a client or patient has cervical spinal trauma and with patients who have clenched teeth.  Indications for this type include intraoral operative procedures, during which the the endotracheal tube could easily be displaced or obscure the operative site.  Bleeding is not unusual after intubation.  The tubes are usually smaller than those used for orotracheal intubation.  This can also be performed with direct visualization with a laryngoscopic          examination.  Blind intubation is only used if there are indications that the larynx can not be visualized.

Orotracheal intubation- the insertion of an  endotracheal tube through the mouth and into the        trachea. This type is performed much more frequently than nasotracheal intubation.

Fiberoptic intubation-(awake)- a fiberoptic scope is used that has an eyepiece to visualize the larynx and a handle to control the tip.  It is usually 2 1/2 – 3 feet long.  It is inserted in the patient’s throat and guided to the larynx and glottic opening.  The endotracheal tube is then slid over the fiberoptic scope into the trachea.  This  procedure is usually used when patient’s are unable to flex and extend their head for any reason.  Usually the patient’s throat is numbed with local anesthesics.  Patients are sedated and made comfortable. Sometimes  the patient is put to sleep.  If general anesthesia is used an assistant is mandatory, because one person can not monitor the patient, administer general anesthesia, and    perform fiberoptic endoscopic examination.

 Tracheostomy intubation- placing a tube by incising the skin over the trachea and making a surgical wound in order to create an airway.  For the best results it is performed over a previously placed endotracheal tube in an operating room. However this is also performed as an urgent, life-saving procedure.

Speaking tracheostomy tubes-  specifically designed tracheostomy tubes that allow the ventilator-dependent client to speak by enabling air to enter the larynx without compromising the patient’s or client’s ventilation.  They keep the air that is needed to ventilate the lungs separate from the air supply for speech.  Currently, there are two types of designs to allow for independent voice control. 

A Electro-mechanical solenoid-  controls the flow from a compressed air source. b. Air compressor-  it can be turned on and off to supply regulated air to the tracheostomy tube.