intubation

the insertion of a tube, as into the larynx; see also cannulation and catheterization. The purpose of intubation varies with the location and type of tube inserted; generally it is done to allow drainage, to maintain an open airway, or to administer anesthetics or oxygen.

Intubation into the stomach or intestine is done to remove gastric or intestinal contents for the relief or prevention of distention, or to obtain a specimen for analysis. Another example of intubation is when a tube is inserted into the common bile duct to allow for drainage of bile from ducts draining the liver, done after surgery on the gallbladder or the common bile duct. Endotracheal intubation can be achieved by insertion of an endotracheal tube, sometimes containing a stylet, via the mouth or nose with the aid of a laryngoscope. It is done for the purpose of assuring patency of the upper airway. tracheostomy is a form of endotracheal intubation.

The insertion of a tube into any hollow organ. Intubation of the trachea provides an open airway and thus is an essential step in advanced life support. It also permits the instillation of certain critical care drugs, such as lidocaine, epinephrine, and atropine, which the lungs can absorb directly when other forms of internal access are unavailable. In the patient with no evidence of head or cervical spine trauma, using a head-tilt, chin-lift maneuver to place the patient in a “sniffing” position facilitates intubation of the trachea. See: illustration

Intubation of other structures, such as the organs of the upper gastrointestinal tract, may permit enteral nutrition, the dilation of strictures, or the visualization of internal anatomy.

The insertion of an endotracheal tube through the nose or mouth into the trachea to maintain the airway, to administer an anesthetic gas or oxygen, or to aspirate secretions.

CAUTION!

Endotracheal intubation can be hazardous to patients with injuries to, or instability of, the cervical vertebra. In trauma patients suspected of cervical fracture, or in patients (such as those with advanced rheumatoid arthritis) who may have an unstable cervical spine, it is safer to use nasotracheal, rather than orotracheal intubation to control the airway.

The improper placement of an endotracheal tube, intended to provide a conduit for air to and from the lungs, into the esophagus. It is a common and potentially life-threatening occurrence during anesthesia and critical illnesses.

Patient care

Health care practitioners have several means at their disposal to try to recognize esophageal intubation. These include direct observation of the endotracheal tube, as it passes through the vocal cords, or capnography.

CAUTION!

Failure to recognize esophageal intubation can result in inadequate oxygenation of the patient.

The insertion of a Levine or other gastrointestinal tube through the nose into the stomach.

The insertion of an endotracheal tube through the nose and into the trachea. Unlike orotracheal intubation, the tube is passed “blindly” without using a laryngoscope to visualize the glottic opening. Because this technique may be used without hyperextension of the neck, it is used in patients suspected of having cervical spinal trauma or known to have oral lesions. Endotracheal tubes inserted nasally need to be of smaller diameter than those inserted orally.

CAUTION!

Endotracheal tubes frequently irritate the nasopharynx, and can cause both bleeding (on insertion), and sinusitis.

An airway control technique that uses powerful sedatives and paralytic drugs to quickly gain control of the airway, e.g., in life-threatening emergencies.

Passage of a tube into the stomach to obtain gastric contents for examination, for prophylaxis and treatment of ileus, to remove ingested poisons, or for feeding.