INTUBATION
© These competencies are
protected by United States Copyright © 1999 - 2002 and
the clinical database system
is Patent Pending to UTMB (University of
Texas Medical Branch at Galveston)
EQUIPMENT AND PATIENT PREPARATION
1.
Evaluates
indication for procedure based on patient assessment (see indications ref #1);
confirm procedure is consistent with patient’s resuscitation orders (e.g.
living will) (2 pts)_____
2.
Reviews
patient chart for significant findings and data (2 pts)_____
3.
Identifies
and gathers the necessary equipment (gloves, endotracheal tubes, stylet,
laryngoscopes and blades, Magill forceps, capnograph or disposable colorimeter,
towels for positioning, tape or tube securing device, syringe, bite block, oral
pharyngeal airway, lubricating jelly, topical anesthetic, suction equipment,
manual resuscitator, appropriate sized mask, oxygen source)
(4
pts)_____
4.
Verify
operation of manual resuscitator, laryngoscope light source, and suction
equipment (3 pts)_____
5.
Applies 3
or more mL of an alcohol-based hand rub to palm and rub hands together covering
all surfaces of each hand until hands are dry (Caution:
should take at least 15 seconds for hands to become dry); or if
hands are visibly dirty or contaminated perform hand wash using a vigorous
rubbing action for at least 10 seconds; and uses appropriate isolation
precautions (CDC-ref. 2) (3 pts)_____
6.
Introduces
self to the patient, stating name, department; confirms patient identification.
(2 pts)_____
7.
Explains
the purpose of the procedure, including risks and safety precautions (2
pts)_____
8.
Confirms
patient and/or family understanding of the procedure (1 pt)_____
IMPLEMENTATION OF PROCEDURE
Endotracheal Intubation
1.
Establishes
open airway by properly positioning patient’s head and neck (3 pts) _____
2.
Hyperoxygenates
with bag-mask device, confirm ventilation by observing chest expansion; have
co-worker confirm breath sounds (3 pts)_____
3.
Monitors
saturation and heart rate and reassess for appropriate ventilation (2 pts)_____
4.
Select
proper size endotracheal tube and confirm function of the cuff; insert stylet
as necessary (3 pts)_____
5.
Inserts
laryngoscope into the right side of the mouth moving left to displace the
tongue; advance blade to displace epiglottis, minimal pressure on teeth (10
pts)_____
6.
Visualize
the glottis and insert the endotracheal tube through the cords until the cuff
has passed the cords by 2-3 cm (ref. 3) (6 pts)_____
7.
Do not
exceed 30 seconds of interrupted ventilation before removing tube and providing
bag-mask ventilation and oxygenation (ref. 4) (5 pts)_____
8.
Stabilize
the tube with the right hand, remove the laryngoscope with the left hand. (2
pts)_____
9.
Inflate the
cuff to seal the airway and immediately provide ventilation and oxygen (ref. 3)
(3 pts)_____
10.
Confirms
airway placement: observe bilateral chest movement and confirm bilateral breath
sounds via auscultation (4 pts)_____
11.
If
assessment of tube position provides inconclusive results apply colorimetry
device or capnograph for further assessment and analysis of potential
esophageal placement (2 pts)_____
12.
If
esophageal intubation is suspected remove endotracheal tube and immediately
provide bag-mask ventilation and oxygenation (2 pts)_____
13.
If proper
placement is confirmed proceed with endotracheal stabilization and secure with
tape or tube securing device; insert oropharyngeal or bite block as necessary
(5 pts)_____
14.
Assure
proper ventilation and oxygenation by manual resuscitator or mechanical
ventilator (2 pts)_____
FOLLOW-UP
1.
Confirm
order for chest x-ray (2 pts)_____
2.
Adjust cuff
pressure to the lowest setting that secures the airway (protects the airway
and/or provides ventilation) using minimal leak technique or minimal occluding
volume (try to maintain pressure below capillary perfusion pressure 24-30 cmH2O
- ref. 5) (2 pts)_____
3.
Evaluates
breath sounds, respiratory rate, saturation, capnograph, and heart rate (2
pts)_____
4.
Confirm
adequate humidification (1 pt)_____
5.
Evaluate
need for secretion removal (1 pt)_____
6.
Provide for
patient communication (e.g. writing surface, letter, phrase, or picture board,
talking adapters) (ref. 3)
(1
pt)_____
7.
Send
laryngoscope, blades and stylet for processing, and discard disposable
equipment appropriately (1 pt)_____
8.
Decontaminates
hands with an alcohol-based hand rub or performs a 15 second hand wash (3 pts)_____
9.
Records
relevant data in patient chart and appropriate departmental records (2
pts)_____
DEMONSTRATES KNOWLEDGE OF FUNDAMENTAL CONCEPTS
1.
Describes the functional
difference between the Miller and MacIntosh blades (1 pt)_____
2.
Describe procedures for
blind and visual nasal intubation (1 pt)_____
3.
What is the maximum time
in seconds that ventilation can be interrupted during an intubation attempt (1
pt)_____
4.
Describe methods for
distinguishing between tracheal and esophageal intubation (1 pt)_____
5.
Describe the ideal tube
position in relation to the carina (1 pt)_____
6.
Describe several
complications associated with prolonged tracheal intubation (ref. 1) (1
pt)_____
CLINICAL COMPETENCY PERFORMANCE CRITERIA
1.
Displays rational
judgment and is able to explain the relationship between theory and clinical
practice.
(2
pts)_____
2.
Performs procedure in a
reasonable time frame and with attention to appropriate detail (2 pts)_____
3.
Maintains aseptic
technique and takes appropriate safety precautions (2 pts)_____
4.
Communicates clearly,
and in a courteous manner (2 pts)_____
Additional Comments: include errors of oversight or sequence, strengths and weaknesses
during procedure (i.e. knowledge, communication skills, and patient interaction
skills)
REQUIRED: Summary
Performance Evaluation
References:
1)
AARC
Clinical Practice Guideline: “Management of Airway Emergencies” RC
1995;40(7):749-760
2)
CDC,
Guideline for Hand Hygiene in Healthcare Settings. MMWR Oct. 25, 2002; vol.
51(No. RR-16)
3)
Scanlan CL,
Spearman CB, Sheldon RL: "Egan's Fundamentals of Respiratory Care” Mosby
7th, 1999, Ch. 29
4)
Textbook of
Advanced Cardiac Life Support. American Heart Association 2000.
5)
McCulloch
TM, Bishop MJ: Complications of translaryngeal intubation. Clin Chest Med 12(3):507-521, 1991.
FINAL EVALUATION
SCORE __________
If a score of 70 or more is not achieved, the evaluation will have to be repeated with the score achieved on any repeat evaluation being multiplied by 0.7 for the final score.
STUDENT SIGNATURE ______________________________________________________
INSTRUCTOR SIGNATURE _____________________________________________________
9/03
Summative Performance Evaluation: Satisfactory ______ Minor
Unsatisfactory ______ Major
Unsatisfactory ______ ___________________________________ Name of person being evaluated ___________________________________ ________________________ Signature of Direct Supervisor Date