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notify extubation means disconnecting patient from mechanical ventilation by removing of endotracheal tube ( ETT ) from airway and mouth .
this procedure was done by icu doctor , and this procedure ICU nurse play a role for maintaince patient airway and maintain breating and oxygentation of patient well and prevent patient desaturated and arrested.
Definition: Extubation is described as the discontinuation of an artificial airway
There should be communication between therapist, nursing and physician staff in order to plan an appropriate time for extubation:
3.1.1 In optimal situations, two individuals will extubate the patient-one with sterile gloves suctioning the patient and the second person hyperventilating the patient and removing the endotracheal tube.
3.2 Assemble the equipment listed in Equipment/Materials.
3.3 Explain the procedure to the patient.
3.4 Place the patient in intermediate or high Fowler’s position.
3.5 Wash hands thoroughly and don gloves and mask. CCMD Share/lr/Policies/Procedures/Airway Management
3.6.2 Select the appropriate suction catheter size for the patient’s airway. 3.6.3 Obtain sterile gloves, syringe, and scissors.
3.7 Hyperoxygenate the patient with 100% O2 prior to extubation.
3.8 Remove tape or Tube Fixation System (TFS) which secures the endotracheal tube.
3.9 Suction the endotracheal tube adequately with pre and post hyperoxygenation and then suction the pharynx above the endotracheal tube cuff.
3.10 Insert a new catheter into the trachea via the endotracheal tube and instruct the patient to breathe slowly and deeply.
3.11 Deflate the cuff or cut the pilot balloon.
3.12 Ask the patient to take a deep breath and to cough, apply vacuum, and at the peak of inspiratory effort, rapidly remove the tube.
3.13 Administer humidified oxygen therapy.
3.14 Continue to evaluate the patient post extubation for signs of respiratory compromise.
1- Explain the procedure to patient & family around.
2- make sure that all necessary equipment are available at bedside such as bag mask attached to oxygen, re-intubation equipment in case patient needed , suction device is ready to suction secretions.
3- monitor spo2 and vital signs on cardiac monitor.
4- monitor effort of patient's breathing.
5- monitor Arterial Blood Gas (ABG) before and after extubation.
6- Once patient is extubated, supply patient with oxygen through non-rebreather face mask or nasal cannula depends on patient's condition until no clinical indication for it.
The Nursing responsibilities during extubation are as follows:
1. Ensure that intubation set is accessible; re-intubation must be anticipated.
2. Check whether the criteria for extubation are all met.
3. Assist the physician in extubating the patient.
4. Simultaneously assist the physician and assess the patient for possible intubation. Assess for stridor.
5. Ensure patent airway. Monitor SPO2.
6. Perform suctioning as needed.
7. Recheck ABG or VBG (as per protocol or as ordered).
8. Position patient on High Fowler's or semi fowlers position.
9. Elicit cooperation with the patient.
the role of Nurses during extubation is first to prepare patient by weaning him or her. patient must be free from sedation and GCS must be more than 8, pain is well controlled and patient must be educated on the process of extubation and must know the expected outcome after he/she is no more connceted to the mechanical ventilator.
exubation is the discontinuation of artificial airway
Active in ICU, ICCU, CASUALTY DEPARTMENT, CPR, DEFIBRILLATION, and Manage of all Critical cases like Hypotension shock, Hypoglycemia, VT, PSVT, and Expert in CAD , MI, ACS, and Monitoring Vital Sign , Actopic, Ventricular Tachycardia
Close Monitoring of patient, ABGS must check every hour or as doctors order needed. To consider CBGS later on. CPT and suction in gas needed.
extubation means disconnecting patient from mechanical ventilation by removing of endotracheal tube ( ETT ) from airway and mouth .
this procedure was done by icu doctor , and this procedure ICU nurse play a role for maintaince patient airway and maintain breating and oxygentation of patient well and prevent patient desaturated and arrested.
Close assessment
vital signs
aspiration
suctioning
ABGS
maintaince patient airway and maintain breating and oxygentation of patient well and prevent patient desaturated and arrested
Assessment includes but is not limited to:-
· Close monitoring of vital signs
· Level of consciousness
· Potential risks associated with extubation such as laryngospasm, vomiting.
· Acceptable ABG values
· Most appropriate choice of oxygen administration after extubation.
· Appropriate positioning to ease the breathing and drainage of secretions
· Checking SpO2.
