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Intubation Procedures for Respiratory Therapists

Intubation is a procedure involving the insertion of an endotracheal tube from the mouth to the airway to assist in breathing. The process of intubation is carried out to provide support to a patient who will undergo surgery or who has difficulty breathing. The procedure is performed by either a physician or a respiratory therapist who has the expertise to perform the procedure.

  1. Respiratory Therapist

    • A respiratory therapist is an allied medical health professional who is trained to administer treatment and therapeutic management to patients with respiratory problems. He can either assist physicians or administer the endotracheal intubation procedure himself.

    Equipment

    • Prior to carrying out the intubation procedure, a respiratory therapist needs to ensure that the necessary equipment is prepared and ready for use. Equipment needed for intubation includes masks, laryngoscopes with straight and curved blades, oropharyngeal airways, endotracheal tube and stylets which may be either a metal or firm rubber as ancillary equipment to maintain the endotracheal tube’s curve while carrying out the intubation procedure. Additional equipment includes 10 cc syringe, water-soluble lubrication, stethoscope and Magill forceps.

    Preparation

    • It is important that the patient is monitored while maintaining airway, breathing and circulation. A respiratory therapist should prepare the equipment for the procedure and position the patient where the mouth, pharynx and trachea are aligned, giving a direct visual of the vocal cords. A towel may be placed under the patient’s shoulder and neck to promote better position for intubation.

    Before Intubation

    • With the equipment and medications in place, the patient is sedated via an intravenous tube. The patient’s vital signs are monitored with a blood pressure cuff and ECG. A clip is also hooked on the patient’s finger that helps monitor the oxygen level. Anesthesia is then administered to put the patient to sleep to begin the intubation procedure.

    During Intubation

    • Once the patient is asleep, a muscle relaxant is given to relax the muscles of the vocal cords and maintain its opening. To visualize the larynx, a blade and handle are used. The tube is inserted between the vocal folds with the help of the stylet. Once the top end of the cuff reaches the vocal folds it is inflated and the patient is then hooked up to the anesthesia machine.

    After Intubation

    • After the procedure, the mask is removed and anesthetics are administered. The machine helps the patient to breathe while supplying gas anesthesia. The patient’s throat is then suctioned. The therapist or the physician waits for the patient to awaken before the process of extubation, or the removal of the endotracheal tube, is done.

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