This is the nasotracheal intubation skill.
The necessary equipment for this skill
is a BVM with an oxygen source
simple airway adjunct
water soluble lubricant
suction with appropriate catheter
endotracheal tube
and a capnography device.
Additionally medication such as viscous lidocaine may be used is available.
The recommended PPE for this skill are gloves and eye protection.
Once I have assembled all the necessary equipment
I'll locate the nostril that is the largest and the least deviated obstructed
Measure and insert a simple adjunct.
Apply a pulse oximeter to the patients index finger
Have my partner assist ventilations at a rate of 10 to 12 breathes per minute
allowing for adequate chest rise.
Auscultate lung sounds bilaterally.
Once the patient is preoxygenated
and I've lubricated the top of the distal tip of the ET tube
I'll have my partner discontinue ventilations
I'll remove the airway adjunct.
Position the patients head.
and insert the ET tube through the nostril.
Once the tube is positioned above the patients vocal chords
I can listen for lung sounds at the end of the tube
or notice misting in the tube.
I will then instruct the patient to take a deep breathe in
while I guide the tube through the vocal chord.
I will also use cricoid pressure.
Insert the tube to the proper depth
and immediately inflate the cuff with a syringe.
Assist ventilations
Have my partner continue ventilations.
while I conform tube placement by auscultating over the lungs and the epigastrium.
I will also confirm tube placement through a secondary device such as an end tidal capnography.
I'll then secure the device.
and then continue to ventilate at an adequate depth and rate
while observing capnography and pulse oximetry.