EXTUBATION
PROCEDURE
BY: HONEIBELLE P. DELACRUZ
EXTUBATED PATIENT
EXTUBATION
• Extubation refers to removal of the endotracheal tube
(ETT).
• It is the final step in liberating a patient from mechanical
ventilation.
• At the end of the weaning process, it may be apparent
that a patient no longer requires mechanical ventilation to
maintain sufficient ventilation and oxygenation.
• However, extubation should not be ordered until it has
been determined that the patient is able to protect the
airway and the airway is patent.
AIRWAY PROTECTION
• Airway protection is the ability to guard against aspiration
during spontaneous breathing.
• It requires sufficient cough strength and an adequate
level of consciousness, each of which should be
assessed prior to extubation.
• The amount of secretions should also be considered prior
to extubation because airway protection is significantly
more difficult when secretions are increased.
CRITERIA FOR EXTUBATION
1. Hemodynamically stable
• No dysrhythmias
• Minimal inotrope requirements
• Optimal fluid balance
2. Adequate ventilation & oxygenation
• FIO2 < 0.5
• Vital capacity of >10ml/kg.
• Tidal volume > 5ml/kg
• Respiratory rate < 25 BPM
CRITERIA FOR EXTUBATION
3. Arterial Blood Gas
• PCO2 < 6kPa.
• PO2 > 8kPa on FIO2 of 40% & PEEP5.
• PH with a normal range (7.35 – 7.45)
4. Other :
• Sedating agents must be stopped for > 24hrs.
• Causative condition resolved/under control.
• Paralysing agents stopped > 24hrs.
• Normal metabolic status. Electrolytes balance must be normal.
• Patient must be neurologically intact. Awake, well motivated, follows
verbal commands & intact gag/ cough reflex.
• Take into consideration aspiration risk and airway edema.
COMPLICATIONS ASSOCIATED WITH ET &
TRACHEOSTOMY TUBES
• Local haemorrhage at tracheostomy site.
• Air embolism
• Infection
• Tracheal necrosis
• Tracheal stenosis
• Tracheoesophageal fistula
• Failure of tracheostomy tube
• Obstruction of tracheostomy
• Accidental extubation
• Tube displacement
• Pneumothorax
• Swallowing dysfunction
Emergency trolley EQUIPMENT
• Suctioning equipment
• Personal protective equipment
• Sterile suction catheter
• Self – inflating manual resuscitating bag – valve device connected
to 100% O2 source.
• O2 source and tubing.
• Scissors
• Supplemental oxygen
• 10ml syringe
• A rigid pharyngeal suction tip ( yankauer)
• Sterile dressing for stoma
• ET intubation supplies
EQUIPMENT
PREPARATION AND ASSESSMENT
1. Ensure the availability and functioning of your oxygen
therapy, suction equipment, emergency equipment.
2. Ensure the privacy of the patient.
3. Explain the procedure to the patient.
4. Assess the patients readiness for extubation:
• Cardiovascular status: BP, HR, Rhythm
• Respiratory status : RR, SpO2
• Neurological status: LOC
• Stop feeds
• Make sure mechanical restraints are off
IMPLEMENTATION
Wash hands put on sterile gloves
• Hyper oxygenate the patient and suction the patient via ET /
tracheostomy tube
• Position the patient in high fowlers position
• Cut & remove tracheostomy tapes/ plaster of ET tube
• Deflate the cuff with 10 ml syringe and instruct the patient to
breath
• Introduce suction catheter into tube
• Ask patient to cough
• Withdraw the tube and suction simultaneously
• Ask patient to cough again ( to determine laryngeal paralysis)
IMPLEMENTATION CONT.
• Remove secretions from oropharynx, mouth and nose and give
a mouthwash.
• Commence O2 therapy via face mask, keep ventilator close for
NIV CPAP
• Encourage patient to breath deeply and do PEEP bottle exercise
• Assessment of the patients respiratory and cardiac status.
• Connect pulse oximeter
• Discard used supplies, remove personal protective equipment
and perform hand hygiene
EVALUATION
• Assess air entry and respiratory status
• Auscultate the chest for breathing sounds and for the presence
of secretions
• Do vital observations
• Remain with the patient to determine respiratory stability
• Obtain arterial blood gas within the next hour
RECORD KEEPING
Tidy up after the procedure
• Wash hands!!!!!
• Record all actions taken and chart vital signs on
observation chart.
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