Emt-P Cl Protocols Confirmation Of Et Tube Placement

Front 1

purpose

Back 1

to confirm and maintain proper placement of the ET tube

Front 2

indications

Back 2

whenever the ET tube is placed proper confirmation must be confirmed in 2 ways, primary and secondary confirmation, must be charted.

-electronic continous end tidal CO2 must be established on every intubated patient

Front 3

Procedure (4)

Back 3

1) Primary confirmation techniques include
a. vusualization of tube pasing the cords
b. 5 point auscultation
c. bilateral cx expansion
d. tube condensation

2) secondary confirmation techniques include
a. esophogeal detector devices are preffered for tube confirmations in adult cardiac arrest victims
b. end tidal CO2 detectors are preferred in non-cardiac arrest victims ACLS class IIa - spontaneous perfusion, class IIb-victim in cardiac arrest
c. electronic capnometry devices

3) after confirming position of the marker on the front teeth as noted during placement of the tube, secure the tube, electronic continous end tidal CO2 must be established on every intubated patient

5) after successful intubation use end tidal monitoring to provide early detection of tube dislodgement

Front 4

Easy Cap

Back 4

1) supplied in adult and child sizes, do not use adult on children less then 33lbs

2) only use if the purple color indicator is the same color or dakjer then the stripe marked check under flourescent light
-under incandescent light conditions use only if the pink color is the same shade or darker then the stripe check

Front 5

Easy Cap precautions and special considerations (6)

Back 5

1) if results not conclusive, the ET tube should be immediatly reinserted unless correct anatomic location can be confirmed with certainty by other means

2) interpreting results before confirming 6 breathes yields false positives

3) easy cap will respond during the presence of a main stem intubation, clinical assessment should be used to confirm position

4) indicator color will continue to fluctuate for up to 2 hours. moisture, humidity, fluids will affect the color fluctuation and accuracy, read on full end expiration, discard if saturated and color no longer changes

5) in cardiac arrest, re-establishment of cardiac output and pulmonary blood flow by adequate CPR is necessary to increase end-tidal CO2 to levels detectable by EASY CAP

6) should not be relied upon as the sole indicator of resusciation performance, especially in cardiac arrest. tube check may be more reliable

Front 6

Tube check

Back 6

preferred for cardiac arrest pt's

1) perform leak test, compress bulb, apply gloved thumb over adapter and release, discard if air leaks

2) insert ET tube and check for proper depth

3) compress tubechek-B, attach to the ET tube and release (DONE PRIOR TO VENTILATION)

4) allow bulb to self inflate
a. if air returns and fills the bulb rapidly (less then 5 seconds) the tube is likely in the trachea, confirm clinically and secure
b. if air fills bulb slowly (5-30seconds) carefully assess ET tube location use direct laryngoscopic visualization if a question still exists, reintubate or support ventilation by alternate means.
c. if air does not fill bulb, or vomit returns, you ar ein the esophagus, reintubate or support ventilation by alternative means

Front 7

Warning tube check (6)

Back 7

1) ET tube obstruction, morbid obesity, pulmonary edema, mainstem bronchus intubation, severe bronchospastic or obstuctive lung disease ay lead to equivocal results due to decreased air for aspiration, direct laryngoscopy recommended

2) pharyngeal intubation may yeild erroneous results, monitor tube depth during intubation, watch kinking

3) use care if storage temperature is near freezing, the bulb will not function

4) do not use in hildren younger 5 years or less then 44lbs

5) use caution if aggressive ventialtion is performed through the ET tube prior to tube check

6) do not use on pregnant women