Page 2263 - Cote clinical veterinary advisor dogs and cats 4th

1123.e8 Intubation, Endotracheal

• Positional catheters that do not allow fluid
flow unless the leg is in a certain position can
sometimes be made functional by applying
VetBooks.ir splints or bandages to the leg to maintain
a desired position.
• Prewrapping the thin strip of tape around
the hub of the catheter can make the initial
taping quicker, but it can also get in the way
(clinician/technician preference).
AUTHOR: Savannah Smith, RVT
EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Thompson, DVM, DABVP

INTRAVENOUS CATHETER PLACEMENT The lateral saphenous vein is an alternative to the cephalic
vein for peripheral catheter placement in dogs.

Intubation, Endotracheal Client Education
Sheet

Difficulty level: ♦ Supplemental equipment: • Do not support or put pressure on the ventral
• Laryngoscope aspect of the animal’s neck.
Synonyms • Local anesthetic • Grasp the animal’s tongue, and use gentle
Placement of a tube into the tracheal lumen • Stylet or guide tube pressure to extend it rostrally and ventrally,
by an oral approach • Sterile, water-soluble lubricant avoiding excessive traction.
• Mouth speculum • With laryngoscope: place tip of blade at base
Overview and Goal of tongue underneath epiglottis, and exert
Endotracheal intubation is performed routinely Anticipated Time downward (ventral) pressure. This disengages
in dogs and cats undergoing general anesthesia • Routine: <30 seconds in an adequately the epiglottis from the soft palate and directs
and is a fundamental technique in emergency/ anesthetized animal it rostrally, allowing the laryngeal opening
critical care situations. • Difficult airway: <3-4 minutes to be visualized. NOTE: Do not place
laryngoscope blade on top of epiglottis.
Indications Preparation: Important • Without laryngoscope: use the endotracheal
• To establish and maintain airway patency Checkpoints tube to disengage the epiglottis from the soft
in animals under general anesthesia • Adequate anesthetic depth required to palate and expose laryngeal opening.
• To protect respiratory tract from aspiration provide good muscle relaxation and inhibit • If local anesthetic is used for desensitizing
of foreign material during anesthesia airway reflexes the larynx (e.g., lidocaine spray), apply it
• To facilitate delivery of supplemental oxygen • Preoxygenation indicated in select animals topically to vocal folds.
and volatile inhalation anesthetic agents • Measurement of tube length and trimming • Advance endotracheal tube between the vocal
• To minimize exposure of hospital personnel if necessary (see Procedure below) folds into trachea. In cats, wait until the folds
to waste anesthetic gases separate during inspiration before attempting
• To minimize anatomic dead space and Possible Complications and to advance tube. Especially useful in cats.
optimize respiratory efficiency Common Errors to Avoid • Do not force tube. If resistance is encoun-
• To facilitate delivery of positive-pressure • Laryngospasm tered, back out slightly, maneuver tip of
ventilation • Trauma to larynx/trachea tube’s bevel between the vocal folds, and
• Vagal reflex activity gently rotate tube while advancing.
Contraindications • Unrecognized esophageal intubation • Ensure that distal portion of tube lies at level
Oral approach may not be possible with man- • Bronchial intubation of thoracic inlet and proximal end terminates
dibular/maxillary trauma, temporomandibular • Postextubation upper airway obstruction at level of animal’s incisors. Tubes may need
disorders, oropharyngeal lesions, or oropharyn- to be shortened to appropriate length before
geal surgery where endotracheal tube placement Procedure placement.
would interfere with the surgical field. • Place anesthetized/unconscious animal in • Tie piece of roll gauze tightly around tube,
sternal recumbency. without constricting lumen, at a point caudal
Equipment, Anesthesia • An assistant opens the animal’s mouth to animal’s incisor teeth. Secure gauze around
Primary equipment: by placing one finger and thumb behind maxilla or back of animal’s head.
• Endotracheal tube of appropriate diameter the maxillary canine teeth. Lips are pulled • Connect endotracheal tube to breathing
and length upward and out of oral cavity. The animal’s system, and begin delivery of oxygen.
• Adequate lighting head and neck are extended to form a straight • Close pop-off valve, and gently squeeze
• Roll gauze to secure tube line. reservoir bag until a pressure of 20 cm H 2 O

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