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.
The most commonly used ETT material in South Africa is polyvinyl chloride (PVC), a transparent plastic that allows the visualization of exhalational condensation (“breath fogging”), secretions, and other foreign materials within the tube. PVC is a semi-rigid material at room temperature, but relatively more pliable as it warms following placement in the trachea, which permits easy manipulation of the tube tip during intubation while reducing the risk of mucosal ischemia following placement. Although not used as commonly, ETTs made of other materials, including nylon, silicone, and Teflon, are also available in the United States.
The size of an ETT signifies the inner diameter of its lumen in millimeters. Available sizes range from 2.0 to 12.0 mm in 0.5 mm increments. For oral intubations, a 7.0-7.5 ETT is generally appropriate for an average woman and a 7.5-8.5 ETT for an average man. However, the appropriate tube size is a multifactorial clinical decision based on patient height and weight, type of procedure or surgery, and the presence of pulmonary or airway disease. For nasal intubations, a reduction in size of 0.5-1.0 mm is appropriate. Length is directly proportional to the ETT size. Nasotracheal tubes are approximately 2 cm shorter than orotracheal tubes. Because anatomic variations of tracheas can be difficult to predict, several sizes of ETT should be readily available prior to intubation.
The appropriate pediatric tube size can be calculated using the formula ID = age in years/4) + 4. For example, a size of 6.0 ETT would generally be appropriate for an 8-year-old patient.