6: Extubation/Decannulation (Assist)

Published on 06/03/2015 by admin

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Last modified 06/03/2015

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Extubation/Decannulation (Assist)

Kirsten N. Skillings and Bonnie L. Curtis

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 following 3–5:

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

• 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

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