Sunday, 4 September 2011

Endotracheal Drugs

When an I.V. line isn't readily available, drugs can be administered into the respiratory system through an endotracheal (ET) tube. This route allows uninterrupted resuscitation efforts and avoids such complications as coronary artery laceration, cardiac tamponade, and pneumothorax, which can occur when emergency drugs are administered intracardially.
Drugs given endotracheally usually have a longer duration of action than drugs given I.V. because they're absorbed in the alveoli. For this reason, repeat doses and continuous infusions must be adjusted to prevent adverse effects. Drugs most commonly given by this route include atropine, epinephrine, and lidocaine.
Endotracheal drugs are usually administered in an emergency situation by a physician, an emergency medical technician, or a critical care nurse. Although guidelines may vary, depending on state, county, or city regulations, the basic administration method is the same. (See Administering endotracheal drugs.)
Endotracheal drugs may be given using the syringe method or the adapter method. Usually used for bronchoscopy suctioning, the swivel adapter can be placed on the end of the tube and, while ventilation continues through a bag-valve device, the drug can be delivered with a needle through the closed stopcock.
ET tube • gloves • stethoscope • handheld resuscitation bag • prescribed drug • syringe or adapter • sterile water or normal saline solution.
Preparation of equipment
Verify the order on the patient's medication record by checking it against the physician's order. In an emergency situation, verify the physician's verbal order. Wash your hands. Check ET tube placement by using a handheld resuscitation bag and stethoscope.
Calculate the drug dose. Adult advanced cardiac life support guidelines recommend that drugs be administered at 2 to 2½ times the recommended I.V. dose. Next, draw the drug up into a syringe. Dilute it in 10 ml of sterile water or normal saline solution. Dilution increases drug volume and contact with lung tissue.
  • Put on gloves.
  • Move the patient into the supine position, and make sure his head is level with or slightly higher than his trunk.
  • Ventilate the patient three to five times with the resuscitation bag. Then remove the bag.
  • Remove the needle from the syringe, and insert the tip of the syringe into the ET tube. Inject the drug deep into the tube.
  • After injecting the drug, reattach the resuscitation bag and ventilate the patient briskly. This propels the drug into the lungs, oxygenates the patient, and clears the tube.
  • Discard the syringe in an appropriate sharps container.
  • Remove and discard your gloves.
Special considerations
Be aware that the drug's onset of action may be quicker than it would be by I.V. administration. If the patient doesn't respond quickly, the physician may order a repeat dose.
Potential complications of endotracheal drug administration result from the prescribed drug, not the administration route.
Record the date and time of drug administration, drug administered, and patient's response.