An endotracheal tube (ETT) is inserted into the trachea to provide a clear airway and facilitate ventilation during general anesthesia, respiratory failure, cardiac arrest, or unconsciousness. The ETT is properly sized and inserted using a laryngoscope to visualize the vocal cords. Placement is confirmed with end tidal CO2 monitoring, chest rise, breath sounds, and cuff palpation before securing. Complications include trauma, laryngeal injury, esophageal intubation, and perforation.

1. ENDOTRACHEAL TUBE / ETT
Dr. HASEEB MANZOOR
Department of Anesthesia
JMCH Karachi

2. ENDOTRACHEAL TUBE / ETT

3. INDICATIONS :
•General Anesthesia
•COMA
•CPR ( CARDIAC ARREST )
•Respiratory failure
•Inability to ventilate the
unconscious patient with
conventional methods
CONTRAINDICATIONS :
•foreign body in pharynx
•When gag reflex is present

4. STRUCTURE

5. SIZE

7. METHOD

8. • Elevate the bed to position the patient's head
at the level of the physician's lower sternum
• The physician stands behind the patient
• Check all equipment ( ETT size , cuff leakage ,
laryngoscope )
• Preoxygenate the patient
• Open the airway by using the heat-tilt-chin-lift
method ( sniffing position )
• Apply lubricant to distal end of tube
• Place a slight curve in the tube to facilitate
entry

9. • The patient's mouth is opened
• Hold laryngoscope in the left hand and insert
blade in patient’s mouth
• blade is inserted on the right side of the
mouth displacing the tongue to the left
• When the blade is fully inserted, Force is then
applied vertically upward on the
laryngoscope, taking care not to place
pressure on the patient's teeth.
• This will raise the epiglottis and expose the
vocal cords.

10. • If you are not able to see the cords, ask an
assistant to apply slight downward pressure
on the cricoid cartilage (Sellick maneuver).
• The tube is then slide along the right side of
the mouth and visualized entering 1/2 to 1
inch into the vocal cords.
• The laryngoscope is removed and the balloon
at the end of the tube is inflated using the 10
ml syringe.
• The tube is then secured to the patient's
mouth using tape

11. CONFIRMATION
• Portable Chest x-ray
• end tidal CO2
• Observe the right and left hemithorax rise and
fall with ventilations.
• Auscultation of bilateral breath sounds. Listen
over the gastric region of the abdomen FIRST
to make sure you are not in the esophagus
• Palpation of the endotracheal cuff in the
sternal notch.

12. COMPLICATIONS
• trauma of lips, teeth, tongue
• Laceration of the pharyngeal or tracheal mucosa
• Injury to the vocal cords
• esophageal intubation
• Laryngeal edema
• cervical spine injury
• Laryngospasm , bronchospasm
• Tachycardia , hypertension
• perforation of the trachea
• Hoarseness of voice

13. PEARLS
• Monitor vital signs and use pulse oximetry
throughout procedure.
• Special care must be taken in any patient where a
C-spine injury is possible. DO NOT LIFT THE CHIN!
The jaw thrust maneuver, with in-line
immobilization should be used.
• While visualising the vocal cords Do not rock the
laryngoscope backwards onto the patient's teeth!
This is a major mistake
• suction the patient's endotracheal tube from time
to time to remove mucus