Pulmonology Book

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Endotracheal Tube Exchange

Aka: Endotracheal Tube Exchange
  1. See Also
    1. Endotracheal Intubation
    2. Advanced Airway
    3. Rapid Sequence Intubation
    4. Endotracheal Intubation Preparation
    5. Post-Intubation Sedation and Analgesia
    6. Endotracheal Tube
    7. Endotracheal Intubation Preoxygenation (and Apneic Oxygenation)
    8. Direct Laryngoscope
    9. Video Laryngoscope (e.g. Glidescope, C-MAC, MacGrath)
    10. Extraglottic Device (e.g. Laryngeal Mask Airway or LMA)
    11. Tactile Orotracheal Intubation (Digital Intubation)
    12. Nasotracheal Intubation
    13. Cricothyrotomy
    14. Needle Cricothyrotomy
  2. Indications
    1. Endotracheal Tube Obstruction
    2. Endotracheal Tube Cuff Rupture
  3. Precautions
    1. High risk procedure
    2. Be prepared to reintubate
    3. Have temporizing measures available (e.g. LMA)
  4. Technique: Preparation
    1. Endotracheal Tubes
      1. Two Endotracheal Tubes (size of cuff to replace and one size smaller)
      2. As usual, test the tube cuffs before use
    2. Gum Elastic Bougie
    3. Video Laryngoscope
    4. Suction
    5. Bag Valve Mask
    6. Waveform Capnography
  5. Technique: Procedure
    1. Procedural Sedation
      1. Deep Sedation (e.g. Propofol, Ketamine, Etomidate) AND
      2. Consider Paralytic (e.g. Rocuronium, Succinylcholine)
    2. Place larygoscope and visualize Endotracheal Tube through Vocal Cords
      1. Maintain visualization of Vocal Cords throughout procedure
      2. Endotracheal Tube or bougie maintains position through cords at all times
    3. Assistant gently inserts Elastic Bougie through Endotracheal Tube
      1. Do not advance bougie past Endotracheal Tube tip
      2. Do not apply force when advancing tube
    4. Remove the Endotracheal Tube after deflating its cuff
      1. Be careful to leave the bougie in place through cords while removing tube
    5. Advance new Endotracheal Tube over bougie
      1. Inflate cuff
      2. Withdraw bougie
      3. Check wave form Capnography
  6. References
    1. Weingart and Swaminathan in Herbert (2020) EM:Rap 20(11): 7-8

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