Due to the severe condition of patients in the intensive care unit, some patients have impaired vital organ function and require mechanical support such as tracheal intubation. Nursing of ICU patients, especially those with endotracheal intubation, is an important aspect of ICU nursing work. This article provides a review of the nursing status of ICU endotracheal intubation patients.
1. The reasons why ICU tracheal intubation patients need nursing care
ICU refers to the intensive care unit, also known as the comprehensive treatment room of the intensive care unit. Almost all hospitals have intensive care units. ICU houses various critically ill or critically ill patients, and most critically ill patients usually have no prior experience with endotracheal intubation. Environmental stressors can also cause a series of psychological and psychiatric symptoms in patients, and it is necessary to strictly follow the doctor's instructions to administer intubation assisted medication injections. So it is very necessary to provide nursing education for ICU endotracheal intubation patients.
2. The purpose of nursing
Tracheal intubation for ICU patients can clear respiratory secretions, avoid aspiration, and provide auxiliary or controlled mechanical ventilation. Similarly, the ultimate goal of providing endotracheal intubation care to ICU patients is for them to actively cooperate with treatment, ensure their life and health, and thus recover as soon as possible.
3. Nursing methods
3.1 Psychological nursing. Patients may experience fear, anxiety, resistance, and other negative emotions and reactions towards the upcoming endotracheal intubation procedure. Nursing staff need to provide psychological counseling to patients and explain the reasons clearly, so that they can actively cooperate with the intubation work. Nursing staff should use friendly language, smile, and have a sincere attitude. Through their external expressions, they can give patients a sense of warmth and security, allowing them to understand that many people care about them and establish a good relationship with them.
3.2 Care before intubation. Explain the purpose, method, and precautions of endotracheal intubation to patients and their families. Usually, most patients who need to be transferred to the ICU for treatment will be in a coma, so the main task for medical staff is to obtain the cooperation of the patient's family. In addition, medical staff should prepare intubation equipment and medication before the patient is intubated, and position the patient in a suitable position for tracheal intubation before performing the procedure.
3.3 Nursing during intubation
(1) Routine nursing. During the actual process of tracheal intubation, nursing staff should closely observe the patient's vital signs, blood oxygen saturation, and electrocardiogram. The ward is quiet, with indoor humidity between 50% -60% and temperature between 20-22 ℃, reducing personnel movement. Prepare first aid supplies and medication in case of emergency. In addition, it is necessary to prevent airway obstruction caused by airbag slippage or excessive secretions. Once the patient is found to be restless, have difficulty breathing, or cyanosis, the cuff airbag should be immediately removed and carefully examined.
(2) During the actual surgical process, nursing staff also need to avoid intubation causing tracheal obstruction in patients. In general, there are two reasons for tracheal obstruction. Firstly, the adhesion of pharyngeal secretions can cause tracheal obstruction. Secondly, blockage caused by dislodgement of the catheter balloon. So, if a patient experiences sudden respiratory distress during endotracheal intubation, the nurse should cooperate with the doctor to remove the intubation balloon and examine the pharynx in order to promptly resolve the tracheal obstruction. Both conscious and unconscious patients should be restrained with limbs to prevent accidental extubation.
(3) For patients with difficulty in expectoration, nursing staff should promptly use a suction device to assist in expectoration and remove phlegm from their trachea. Accurately collect sputum specimens, observe the amount, nature, color, and odor of sputum, and record it. ① Choose a suitable suction tube to minimize damage to the airway. Therefore, the diameter of the suction tube should be half that of the endotracheal tube to ensure that the probability of suffocation is reduced during suction and to avoid excessive negative pressure leading to atelectasis. ② Insert the suction tube into the deepest part and lift it up slightly by 1cm. Rotate and withdraw while turning on negative pressure. When suctioning, keep the movement gentle and do not repeatedly lift or insert it up and down in the trachea.
(4) Fully humidified. After the patient's trachea is cut open, it basically loses its ability to self humidify, and is prone to a series of complications such as airway obstruction, secondary infection, and atelectasis. Therefore, the following methods should be used in clinical nursing to fully humidify. There are two commonly used methods for humidification care, one is intermittent humidification and the other is continuous humidification. The indirect humidification method mainly involves injecting 250ml of physiological saline and 15mg of ambroxol hydrochloride into the patient's trachea after each sputum aspiration, with each injection ranging from 2ml to 5ml. In addition, nursing staff can also use steam inhalers or nebulizers for humidification care. The continuous humidification method mainly uses a drip method, which involves passing the humidification solution through a scalp needle and adding other drugs according to the patient's actual condition for drip administration.
3.4 Post intubation care. Prevent local infections. Replace the dressing used for tracheal incision in a timely manner every day, and strictly disinfect it with 0.5% concentration of iodine according to aseptic operation to avoid cross infection.
The nursing quality, treatment effectiveness, and patient prognosis of ICU endotracheal intubation patients are closely related. Nursing staff need to carry out nursing interventions according to relevant operating standards to facilitate the subsequent treatment of critically ill patients.