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.