Intubação Traqueal: materiais necessários e como preparar

Summary

In this video, Janaína, an intensive care nurse, provides a comprehensive guide to tracheal intubation. She explains the indications for intubation, the essential materials required, and detailed steps involved in both the preparation and execution of the procedure. From oxygenation to securing the tube, she emphasizes the importance of collaboration, safety, and proper technique in managing difficult airways. Additionally, Janaína outlines post-intubation care, including cuff pressure monitoring, patient positioning, and routine hygiene practices, all crucial to preventing complications and ensuring successful mechanical ventilation.

Takeaways

• 😀 Intubation is a medical procedure, but nurses and other healthcare professionals assist in the process by preparing necessary materials and supporting the procedure.
• 😀 The procedure is indicated when patients experience failure of the neurological, cardiovascular, or respiratory systems, including unconsciousness or the inability to protect their airway.
• 😀 There are two main types of intubation: orotracheal (via the mouth) and nasotracheal (via the nose), with orotracheal being more common in practice.
• 😀 Essential materials for intubation include an intubation tube, laryngoscope, suction system, and various medications such as anesthetics and muscle relaxants.
• 😀 The laryngoscope must be fully functional, with its light working properly, before starting the procedure.
• 😀 Pre-oxygenation of the patient is vital for a successful intubation. This can be done using a bag-valve-mask or a non-rebreather mask connected to an oxygen source.
• 😀 Intubation tubes come in various sizes, and it's important to have a selection of tubes ready for different patient needs.
• 😀 The cuff of the intubation tube should be tested before use to ensure it's functioning properly and can maintain a secure airway.
• 😀 The guide wire (bougie) can be used if intubation is difficult, helping to position the tube correctly in the trachea without damaging it.
• 😀 After intubation, it’s essential to secure the tube using a lace or strap and verify proper tube placement with auscultation, ensuring the patient is ventilated correctly.
• 😀 Once intubated, the patient should be connected to a mechanical ventilator, and the cuff pressure should be monitored regularly to avoid complications like aspiration or ventilator-associated pneumonia.

Q & A

What is the primary purpose of tracheal intubation?

The primary purpose of tracheal intubation is to secure the airway in patients who have respiratory, neurological, or cardiovascular failure, or who cannot protect their airway, preventing risks like aspiration and ensuring proper gas exchange.

When is tracheal intubation typically indicated?

Tracheal intubation is indicated when a patient has a diminished level of consciousness, cannot protect their airway, is at risk for aspiration, or is experiencing respiratory failure or neurological conditions such as severe shock or neurodegenerative diseases.

What are the two main types of intubation mentioned in the video?

The two main types of intubation are orotracheal intubation (through the mouth) and nasotracheal intubation (through the nose).

What are some essential materials required for performing tracheal intubation?

Essential materials include a laryngoscope with blades, endotracheal tubes in various sizes, a bag-valve-mask (BVM) device, laryngeal mask airway (LMA), a cuff pressure monitor, a suction system, a syringe for testing the cuff, and medications like analgesics, anesthetics, and muscle relaxants.

What is the purpose of pre-oxygenation in the intubation process?

Pre-oxygenation is used to ensure the patient has enough oxygen before the procedure, which can help prevent hypoxia during intubation. It can be achieved using a BVM device or a non-rebreathing mask, with the oxygen flow set to 15 liters per minute.

What are the steps involved in the actual intubation procedure?

The steps in the intubation procedure include preparing materials, pre-oxygenating the patient, performing laryngoscopy to visualize the airway, inserting the endotracheal tube, confirming tube placement through auscultation, and securing the tube in place.

Why is it important to check the cuff pressure before proceeding with intubation?

It is important to check the cuff pressure to ensure proper inflation of the cuff, which helps seal the airway and prevents leakage of air and aspiration. The cuff pressure should ideally be maintained between 18 mmHg to 25 mmHg.

What role does the 'bougie' play in the intubation process?

The bougie is used as a guide when the laryngoscope cannot visualize the airway clearly or when the endotracheal tube is misplaced, such as when it enters the esophagus instead of the trachea. It helps direct the tube into the correct position.

What is the purpose of using a laryngeal mask airway (LMA) during intubation?

The laryngeal mask airway (LMA) is used when intubation is difficult or not immediately possible. It provides a secure airway quickly and is often used in cases where a rapid airway intervention is needed.

How should the endotracheal tube be secured after intubation?

After intubation, the tube should be secured using a fixation method, such as tying the tube with a cord or using adhesive strips. Proper fixation prevents the tube from dislodging and ensures it stays in the correct position throughout the procedure.