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    Extubation OR Decannulation (Assist)

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    ydtrgn
    This document provides guidance on assisting with extubation and decannulation procedures. It outlines the purpose of removing artificial airways, prerequisite nursing knowledge, necessary equipment, patient and family education considerations, and steps for assessing patient readiness and preparing them. Key points include assessing stable respiratory status, ability to cough and clear secretions, educating the patient and family on the procedure and post-procedure expectations, and verifying the correct patient before assisting with the planned procedure.

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    Extubation OR Decannulation (Assist)

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    ydtrgn
    54 views5 pages
    This document provides guidance on assisting with extubation and decannulation procedures. It outlines the purpose of removing artificial airways, prerequisite nursing knowledge, necessary equipment, patient and family education considerations, and steps for assessing patient readiness and preparing them. Key points include assessing stable respiratory status, ability to cough and clear secretions, educating the patient and family on the procedure and post-procedure expectations, and verifying the correct patient before assisting with the planned procedure.

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    This document provides guidance on assisting with extubation and decannulation procedures. It outlines the purpose of removing artificial airways, prerequisite nursing knowledge, necessary equipment, patient and family education considerations, and steps for assessing patient readiness and preparing them. Key points include assessing stable respiratory status, ability to cough and clear secretions, educating the patient and family on the procedure and post-procedure expectations, and verifying the correct patient before assisting with the planned procedure.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    54 views5 pages

    Extubation OR Decannulation (Assist)

    Uploaded by

    ydtrgn
    This document provides guidance on assisting with extubation and decannulation procedures. It outlines the purpose of removing artificial airways, prerequisite nursing knowledge, necessary equipment, patient and family education considerations, and steps for assessing patient readiness and preparing them. Key points include assessing stable respiratory status, ability to cough and clear secretions, educating the patient and family on the procedure and post-procedure expectations, and verifying the correct patient before assisting with the planned procedure.

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    © All Rights Reserved
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    of 5

    P R OC E D UR E 6

    Extubation/Decannulation (Assist)
    Kirsten N. S killings and Bonnie L. Curtis

    PURPOSE:
    The purpose of extubation and decannulation is to remove the artificial airway to allow the patient to breathe
    independently.

    PREREQUISITE NURSING KNOWLEDGE


    • Extubation refers to removal of an endotracheal tube, and decannulation refers to removal of a tracheostomy tube.
    • Indications for extubation and decannulation include the following3-5 :
    v. The underlying condition that led to the need for an artificial airway is reversed or improved.
    v. Hemodynamic stability is achieved, with no new reasons for continued artificial airway support.
    v. The patient is able to effectively clear pulmonary secretions.
    v. Airway problems have resolved; minimal risk for aspiration exists.
    v. Mechanical ventilatory support is no longer needed.
    • Most extubations or decannulations are planned. Planning allows for preparation of the patient physically and
    emotionally and decreases the likelihood of reintubation and hypoxic sequelae. Unintentional or unplanned
    extubation complicates a patient’s overall recovery.1
    • Extubation may occur in a rapid fashion when the previous indications are met, whereas decannulation generally
    occurs in a stepwise fashion. A patient with a tracheostomy tube may be weaned gradually from the tracheostomy
    tube, possibly with a combination of techniques, including downsizing the tube diameter, using tubes and inner
    cannulas with fenestrations, and capping the tracheostomy. The tracheostomy tube is removed when the patient is
    able to breathe comfortably, maintain adequate ventilation and oxygenation, and manage secretions, through the
    normal anatomic airway.

    EQUIPMENT
    • Suctioning equipment
    • Personal protective equipment
    • Sterile suction catheter or suction kit
    • Self-inflating manual resuscitation bag-valve-device connected to 100% oxygen source
    • Oxygen source and tubing
    • Scissors
    • Supplemental oxygen with aerosol
    • 10-mL syringe
    • Rigid pharyngeal suction-tip (Yankauer) catheter
    • Sterile dressing for tracheal stoma
    Additional equipment, to have available as needed, includes the following:
    • Endotracheal intubation supplies
    • Emergency cart

    PATIENT AND FAMILY EDUCATION


    • Explain the procedure and the reason the endotracheal tube or tracheostomy tube is no longer needed. Rationale:
    This process identifies patient and family knowledge deficits concerning the patient’s condition, procedure, and
    expected benefits and allows time for questions to clarify information and voice concerns. Explanations decrease
    patient anxiety and enhance cooperation.
    • Explain the purpose and necessity of extubation or decannulation. Rationale: Communication and explanation for
    therapy encourage cooperation and minimize anxiety.
    • Discuss the suctioning process and the importance of coughing and deep breathing. Rationale: Understanding
    therapy encourages cooperation with the follow-up procedures necessary to maintain a patent airway.
    • Explain that the patient’s voice may be hoarse after extubation or decannulation. With removal of a tracheostomy
    tube, occlusion of the stoma may be necessary to facilitate normal speech and coughing. Rationale: Knowledge
    minimizes patient and family fear and anxiety.
    • Explain that the patient may need continued oxygen or humidification support. Rationale: Many patients continue
    to need oxygen support for some time after extubation. Continued humidification often helps to decrease hoarseness
    and liquefies secretions.

    PATIENT ASSESSMENT AND PREPARATION


    Patient Assessment
    • Desired level of consciousness has been achieved (in most cases, the patient is awake and able to follow commands).5
    • Assess the stability of the patient’s respiratory status2,4,5 :
    • Stable respiratory rate of less than 25 breaths/min
    • Absence of dyspnea
    • Absence of accessory muscle use
    • Negative inspiratory pressure less than or equal to ?20 cm H2 O
    • Positive expiratory pressure greater than or equal to +30 cm H2 O
    • Spontaneous tidal volume greater than or equal to 5 mL/kg
    • Vital capacity greater than or equal to 10 to 15 mL/kg
    • Minute ventilation greater than or equal to 10 L/min
    • Fraction of inspired oxygen less than or equal to 50%
    • Stable pulse and blood pressure and absence of serious cardiac dysrhythmias Rationale: Evaluation of the patient’s
    respiratory status identifies that intubation is no longer necessary. Signs and symptoms associated with independent
    breathing are as follows.2,4,5
    • Assess the patient’s ability to cough. Rationale: The ability to cough and clear secretions is important for successful
    airway management after extubation.

    Patient Preparation
    • Verify correct patient with two identifiers. Rationale: Prior to performing a procedure, the nurse should ensure the
    correct identification of the patient for the intended intervention.
    • Ensure that the patient understands preprocedural teachings. Answer questions as they arise, and reinforce
    information as needed. Rationale: This process evaluates and reinforces understanding of previously taught
    information.
    • Place the patient in a semi-Fowler’s position. Rationale: Respiratory muscles are more effective in an upright
    position versus a supine position. This position facilitates coughing and minimizes the risk of vomiting and
    consequent aspiration.
    Procedure for Assisting with Extubation and Decannulation
    References
    1. O’Meade, M, Guyatt, G, Cook, D, Weaning from mechanical ventilation. the evidence from clinical research.
    Respir Care 2001; 12:78–83.
    2. Pierce, L, Airway maintenance. In Management of the mechanically ventilated patient. ed 2. Saunders, St Louis,
    2007.
    3. Scales, K, Pilsworth, J. A practical guide to extubation. Nurs Stand. 2007; 22(2):44–48.
    4. St John, RE, Seckel, MA, Airway managementBurns SM, ed.. AACN protocols for practice . care of mechanically
    ventilated patients. ed 2. Jones and Bartlett Publishers, Sudbury, MA, 2007:1–57.
    5. Twibel, R, Siela, D, Mahmoodi, M. Subjective perceptions in physiological variables during weaning from
    mechanical ventilation. Am J Crit Care. 2003; 12:12–101.

    Additional Readings
    Americ an Assoc iation for Respiratory Care, Clinic al prac tic e guideline. removal of the endotrac heal tube. Respir Care. 2007; 52(1):81–93.
    Burns, S M, Weaning from mec hanic al ventilationBurns S M, ed.. AACN protoc ols for prac tic e. c are of mec hanic ally ventilated patients. ed 2. Jones and Bartlett
    Publishers, S udbury, MA, 2007:97–160.
    Ead, H, Post anesthesia trac heal extubation . CACCN. 2004; 15(3):20–25.
    Henneman, E. Liberating patients from mec hanic al ventilation. a team approac h. Crit Care Nurse 2001; 21:25–33.

    This proc edure should be performed only by physic ians, advanc ed prac tic e nurses, and other healthc are professionals (inc luding c ritic al c are nurses)

    with additional knowledge, skills, and demonstrated c ompetenc e per professional lic ensure or institutional standard.

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