Types of intubation

   Endoctracheal intubation-  the passage of a tube through 

        the nose or mouth into the trachea for maintenance of the 

     airway during anesthesia or for maintenance of an imperiled 

     airway.  This is considered a relatively temporary 

      procedure. The type of intubation used depends on the 

      patient's condition and on the purpose for intubation.

          Nasogastric intubation- the insertion of an 

              endotracheal tube through the nose and into the 

              stomach to relieve excess air from the stomach or to 

              instill nutrients or medications..  

          Nasotracheal intubation- (blind) the insertion of 

               an endotracheal   tube through the nose and into the 

               trachea. The tube is passed  without using a 

               laryngoscope to view the glottic opening.  This 

               technique may be used without hyperextension, 

               therefore it is useful when a client or patient 

                 has cervical spinal trauma and with patients who have 

                 clenched teeth.  Indications for this type include 

              intraoral operative procedures, during which the the 

               endotracheal tube could easily be displaced or obscure 

              the operative site.  Bleeding is not unusual after 

              intubation.  The tubes are usually smaller than those 

              used for orotracheal intubation.  This can also be 

              performed with direct visualization with a laryngoscopic 

              examination.  Blind intubation is only used if there are 

              indications that the larynx can not be visualized.

          Orotracheal intubation- the insertion of an         

              endotracheal   tube through the mouth and into the 

              trachea. This type is performed much more frequently 

              than nasotracheal intubation.

          Fiberoptic intubation-(awake)- a fiberoptic scope is 

              used that has an eyepiece to visualize the larynx and a 

             handle to control the tip.  It is usually 2 1/2 - 3 feet 

             long.  It is inserted in the patient's throat and guided to 

             the larynx and glottic opening.  The endotracheal tube is 

            then slid over the fiberoptic scope into the trachea.  This 

            procedure is usually used when patient's are unable to 

           flex and extend their head for any reason.  Usually the 

           patient's throat is numbed with local anesthesics.  

           Patients are sedated and made comfortable.  Sometimes 

           the patient is put to sleep.  If general anesthesia is used 

           an assistant is mandatory, because one person can not 

           monitor the patient, administer general anesthesia, and 

           perform fiberoptic endoscopic examination.

          Tracheostomy intubation- placing a tube by incising 

              the skin over the trachea and making a surgical wound 

              in order to create an airway.  For the best results it is 

             performed over a previously placed endotracheal tube in 

            an operating room. However this is also performed as an 

            urgent, life-saving procedure.

             Speaking tracheostomy tubes-  specifically designed           

                tracheostomy tubes that allow the ventilator-dependent

           client to speak by enabling air to enter the larynx without

          compromising the patient's or client's ventilation.  They 

           keep the air that is needed to ventilate the lungs separate 

           from the air supply for speech.  Currently, there are two 

          types of designs to allow for independent voice control.

           a.  Electro-mechanical solenoid-  controls the flow from

              a compressed air source.

              b. Air compressor-  it can be turned on and off to 

             supply regulated air to the tracheostomy tube.