Methods of Use of Tracheal Tube

1. How to use the tracheal tube through the oral cavity

After exposing the glottis under direct vision with the help of a laryngoscope, insert the tracheal tube into the trachea through the oral cavity.

(1) Tilt the patient's head back, hold the lower jaw forward and upward with both hands to open the mouth, or use the thumb of the right hand to face the lower dentition and the index finger to the upper dentition to open the mouth by rotating force.

(2) Hold the laryngoscope handle in the left hand and put the laryngoscope lens into the mouth from the right corner of the mouth, push the tongue to the side and then slowly advance, and the uvula can be seen. Lift the lens vertically until the epiglottis is exposed. Stir up the epiglottis to expose the glottis.

(3) If a curved lens cannula is used, place the lens at the junction of the epiglottis and the root of the tongue (epiglottis valley), and lift it forward and upward to make the hyoid epiglottic ligament tense, and the epiglottis cocked close to the laryngeal lens to expose the glottis. If a straight lens cannula is used, the epiglottis should be directly provoked, and the glottis can be exposed.

(4) Hold the middle and upper sections of the tracheal tube with the right thumb, index finger and middle finger like holding a pen, and enter the oral cavity from the right corner of the mouth. The narrow gap between the tube walls monitors the forward direction of the catheter, and inserts the tip of the catheter into the glottis accurately and lightly. When intubating with the help of a tube core, after the tip of the catheter enters the glottis, the tube core should be pulled out before inserting the catheter into the trachea. The insertion depth of the catheter into the trachea is 4-5cm for adults, and the distance from the tip of the catheter to the incisor is about 18-22cm.

(5) After the intubation is completed, confirm that the catheter has entered the trachea and then fix it. Confirmation methods are:

① When the chest is pressed, there is airflow at the catheter port.

② During artificial respiration, symmetrical undulations of both sides of the thorax can be seen, and clear alveolar breathing sounds can be heard.

③ If a transparent catheter is used, the tube wall is clear when inhaling, and obvious "white fog"-like changes are visible when exhaling.

④ If the patient breathes spontaneously, the respiratory sac can be seen to expand and contract with breathing after receiving the anesthesia machine.

⑤ It is easier to judge if the end-expiratory ETCO2 can be monitored, and if the ETCO2 graph is displayed, the correctness can be confirmed.

2. How to use the tracheal tube through the nasal cavity

Insert the tracheal tube into the trachea through the nasal cavity under non-clear vision conditions.

(1) Spontaneous breathing must be retained during intubation, and the direction of the catheter's advancement can be judged according to the strength of the exhaled airflow.

(2) Use 1% tetracaine as the internal surface anesthesia of the nasal cavity, and instill 3% ephedrine to constrict the blood vessels of the nasal mucosa to increase the volume of the nasal cavity and reduce bleeding. Choose a tracheal tube with a suitable diameter and insert it into the nasal cavity with the right hand tube. During the intubation process, listen to the strength of the exhaled air flow while advancing, while adjusting the position of the patient's head with the left hand to find the strongest position of the exhaled air flow.

(3) Push the catheter quickly when the glottis is opened. When the catheter enters the glottis, the advancing resistance is reduced, and the exhalation airflow is obvious. Sometimes the patient has a cough reflex. When the anesthesia machine is connected, the breathing bag expands and contracts with the patient's breathing, indicating that the catheter is inserted into the trachea.

(4) If the exhalation airflow disappears after the catheter is advanced, it is a manifestation of insertion into the esophagus. The catheter should be retracted to the nasopharynx, and the head should be tilted slightly so that the tip of the catheter can be tilted upwards, which can be aligned with the glottis to facilitate insertion.