A physician has requested your assistance in extubating an orally intubated patient. Which of the following should be done before the tube itself is removed?

Question

1. Suction the orolaryngopharynx
2. Preoxygenate the patient
3. Suction the endotracheal tube
4. Confirm cuff inflation
a. 2 and 4 only
b. 1, 2, and 4 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

Answer 1

ANS: D
Step 1: Assess Patient for Indications. Generally, a patient should never be suctioned according to a preset schedule. Although very thick secretions may not move with airflow and may not cre-ate any adventitious sounds, the patient should be assessed for clinical indicators, such as rhonchi heard on auscultation, which suggest the need for suctioning Step 2: Suction the Endotracheal Tube and Pharynx to Above the Cuff. Suctioning before extubation helps prevent aspiration of secretions after cuff deflation. After use, dispose of the first suction kit and prepare another for use, or prepare a rigid tonsillar (Yankauer) suction tip. Because patients will often cough after the tube is pulled, you may need to help them clear secretions.
Step 3: Oxygenate the Patient Well After Suctioning. Extubation is a stressful procedure that can cause hypoxemia and unwanted cardiovascular side effects. Administer 100% oxygen for 1 to 2 min to help avoid these problems.
Step 4: Deflate the Cuff. Attach the 10 or 12 ml syringe to the pilot tubing. Withdraw the air from the cuff while applying positive pressure to direct any pooled secretions above the cuff up into the oropharynx where they can immediately be suctioned with the tonsillar suction tip. Lis-ten for an audible leak around the tube. If no audible leak is present reinflate the cuff and discuss with the physician how to proceed.