Intubation

Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Most commonly, intubation refers to tracheal intubation, a procedure during which an endotracheal tube is inserted into the trachea to support patient ventilation. Other examples of intubation include balloon tamponade using a Sengstaken–Blakemore tube (a tube into the gastrointestinal tract), urinary catheterization, and nasogastric intubation using a feeding tube.

Tracheal intubation is a procedure involving the placement of an endotracheal tube into a patient's windpipe, also known as the trachea. This procedure may be done to treat either emergency or non-emergency conditions. Examples of emergency conditions include airway compromise, respiratory failure, allergic reactions, and trauma. An example of a non-emergency condition where tracheal intubation is performed includes surgery, during which an individual may not be able to breathe on their own as a result of anesthetic medications.

Nasogastric intubation occurs when a nasogastric tube is placed. This procedure may be used to treat conditions that prevent the regular passage of food through the mouth to the rest of the GI system. Conditions where there passage of normal GI contents may be interrupted includes head and neck cancers, bowel obstruction, and conditions that cause difficulty swallowing (also known as dysphagia). Nasogastric intubation may also be used to treat malnutrition, poisoning, upper GI bleeding, surgery, and to administer medications.

Urinary intubation via a catheter is often used to help relieve obstructions to the passage of urine. Obstructions can be caused by a variety of conditions, including urinary incontinence, prostate enlargement, or tumors. Catherization can also be done to relieve urinary retention caused by infections, trauma, or medications. Catheterization may also be performed during surgery or to administer medications directly to the bladder.

Tracheal intubation involves the placement of a tube, known as an endotracheal tube, into the mouth or nose. Intubation first begins with the use of anesthesia medications, usually delivered through an IV, to place the patient to sleep. Next, extra oxygen is administered to the patient through a face mask. Once the patient is asleep, an anesthesia provider will tilt the patient's head back and insert a viewing device, also known as a laryngoscope, into the patient's mouth. The laryngoscope is accompanied by a dull blade to help move other oral structures, such as the tongue, out of the way. Once the anesthesia provider identifies the epiglottis, which covers the larynx, the epiglottis is manually lifted using the laryngoscope. The endotracheal tube is inserted through the larynx past the vocal cords and secured by inflating a small balloon at the end of the endotracheal tube. Once secured, the laryngoscope is removed. The tube is then secured at the mouth, often using tape or with a strap that wraps around the patient's head. Finally, correct placement is verified by listening to both lungs for breath sounds.

Prior to placing a nasogastric tube, first involves measuring the correct length needed to have the tube reach the stomach. The most commonly used method used worldwide involves measuring the distance of the tube from the tip of the nose to the patient's earlobe to the xiphoid. Next, the first few inches of the tube is lubricated to facilitate placement. Some providers may also use a lidocaine spray to help numb the sinus cavity and throat. Next, the tube is inserted through the nostril and advanced to the back of the throat. Once the tube is in the back of the throat, the patient is instructed to take small sips of water as the tube is advanced through the esophagus. Once the nasogastric tube is inserted at the correct length, as determined previously, the tube is secured via tape. Verification of correct placement most commonly involves the use of a chest X-ray, where the end tip of the tube can be seen in the stomach.

One of the most common forms of urinary catheterization involves a type of catheterization known as Foley catheterization. During this procedure, a healthcare provider begins by sterilizing the genital area. Next, an anesthetic gel may be applied to ease discomfort. The Foley catheter is then lubricated with gel before being inserted into the urethra. Once the catheter has been advanced into the bladder, a small balloon located toward the tip of the catheter is inflated to secure it into place. Lastly, the Foley catheter and bag is secured to the patient's leg.

Each type of intubation may be associated with different complications and/or risks. Common complications include infection, particularly with urinary catheterization, as well as those associated with misplacement.