Intubation

Insertion of an endotracheal tube to secure the airway

Definition

Intubation is the placement of a flexible tube into the trachea to maintain airway patency, protect against aspiration, and allow mechanical ventilation.

Indications

Respiratory failure
Airway protection (GCS ≤ 8)
Cardiac arrest
Surgery requiring general anesthesia
Anticipated airway compromise (burns, angioedema)

Pre-Procedure

Pre-oxygenate with 100% oxygen, confirm equipment (laryngoscope, ETT, stylet, suction), pre-medicate (sedation, paralysis), positioning (sniffing position).

Post-Intubation Verification

Primary: End-tidal CO2 detector (waveform capnography = gold standard)
Auscultation: Bilateral breath sounds (right mainstem intubation if only right side heard; pull back 1 to 2 cm)
Chest x-ray for definitive placement. ETT tip 3 to 5 cm above carina
No epigastric sounds
Chest rise

Nursing Care

Oral care per ventilator bundle, HOB 30 to 45°, suction as needed, sedation management, DVT and stress ulcer prophylaxis, prevent VAP.

NCLEX Relevance

Confirm placement with CO2 detector AND chest x-ray.