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Florence Yap, Ho Oi Man, Charles Gomersall, Gavin Joynt
- Only experienced doctors should attempt intubation (spread of infection at
the time of intubation appears to be associated with difficult intubation,
prolonged manual bagging)
- Muscle relaxants should be used to facilitate intubation and minimize the
risk of the patient coughing
- Prepare all drugs and equipment in advance including end-tidal CO2
monitor.
- Prepare
manual bag-valve resuscitator
- Attach high quality bacterial/viral filter to the endotracheal tube
via a catheter mount before intubating (this is designed to minimize the
risk to staff if the patient coughs).
- Prepare
ventilator
- Ensure that all connections are compatible.
- Set the ventilator prior to intubation but leave it in standby mode until it is
connected to the ETT.
- Before intubation assign one person to listen to chest to exclude endobronchial intubation.
(This person should not be in close proximity to the patient during
intubation and should only return to the area to confirm that the tip of the
ETT is not in a bronchus). All other staff involved in the intubation should
then go to the de-gowning area to remove personal protection equipment and
then go to the gowning area to don new equipment, adding a hood for
additional protection.
- If the procedure is a change of endotracheal tube use a nerve stimulator
to ensure the patient is adequately paralysed before attempting laryngoscopy.
- Minimize manual bagging. If essential, should be carried out by two
members of staff
- one person holds mask tightly against patient's face
- other person squeezes bag gently
- Inflate ETT cuff before ventilating the patient
- All staff involved in the intubation should remove personal protection
equipment and don new equipment immediately after the intubation.
© Florence Yap, Ho Oi Man, Charles Gomersall, Gavin Joynt,
September 2003, January 2004 |
