The soft-shaped tracheal intubation should be fixed together with the hard tooth pad. It can be double-fixed with adhesive tape and tape to prevent displacement or detachment. The tape should not be too tight to prevent deformation of the lumen. Regularly measure the tracheal intubation and the scale in front of the incisors and record it. At the same time, restrain the hands with a restraint band to prevent the patient from extubation and damaging the throat when he is awake or complicated with mental symptoms. Replace dental pads and tapes daily, and perform oral care.
2. Keep the tracheal tube open
Suction the oral cavity and tracheal secretions in time, pay attention to aseptic operation when sputum suction, mouth, tracheal suction tube must be strictly separated. The suction tube and oxygen suction tube should not exceed 1/2 of the inner diameter of the tracheal tube, so as not to block the airway. Each suction is done one tube at a time, and the suction tube stays in the airway for less than 15 seconds.
3. Keep the airway moist
The concentration of oxygen inhalation should not be too large, generally 1-2 liters / minute is appropriate. The oxygen inhalation needle is inserted into the tracheal tube half. When the sputum is viscous, inhale it every 4 hours, or drip the humidified solution into the trachea, 2-5ml each time, not more than 250ml for 24h.
4. Keep track of the location of the tracheal tube
You can know the position and depth of the catheter by auscultating the breathing sounds of the lungs or X-rays. If the breathing sounds disappear on one side, it may be that the trachea is inserted into the lungs and needs to be adjusted in time.
5. Suitable airbag elasticity
Deflate every 4h for 5-10 minutes, and suck the oropharynx and tracheal secretions before deflating. The tracheostomy should be considered after the tracheal tube is retained for 72 hours to prevent the balloon from compressing the tracheal mucosa for a long time, causing ischemia and necrosis of the mucosa.
6. Extubation procedure
① Indications for extubation: The patient is conscious, the vital signs are stable, the cough reflex is restored, the sputum is strong, and the tracheal tube can be pulled out if the muscle tone is good.
② Explain to the patient well before extubation and prepare an oxygen mask or nasal cannula.
③ Aspiration of oral secretions, full suction of sputum in the trachea, and pressurized oxygen with a breathing sac for one minute.
④ Unfasten the tape and tape of the tracheal tube, place the suction tube at the deepest point of the tracheal tube, suck the sputum while pulling the tube, and immediately give oxygen to the mask after removing the tube.
7. Nursing after extubation:
① Observe the clinical manifestations of patients with hypoxia and dyspnea such as nasal fan, shallow breathing, cyanosis of the lip, and accelerated heart rate.
② Cut the bag by the bedside gas pipe. Severe throat edema, tracheotomy immediately after inhalation for 20 minutes or 5 mg of dexamethasone infusion, but no relief.