EQUIPMENT
Appropriately sized resuscitation equipment (mask, valve,

bag)

Oxygen and humidity delivery source
Suction source, canister, and connecting tubing
Gloves, mask, goggles, gown (as appropriate)
Yankauer suction or closed port suction
Sterile suction kit (appropriately sized for ETT)

Size of ETT

Size of suction catheter

2.5–3.0

5

1

/

2

–6 French

3.5–4.5

8 French

5.0–6.7

10 French

7.0–10.0

14 French

Sterile unit dose normal saline and water
Sterile single use water container
Benzoin
Tape, 2

× 2 gauze

Hypoactive dressing
Tape remover
3-way stopcock
Pressure manometer
5 ml syringe
Stethoscope
Pulse oximeter
Cardiorespiratory monitor
Moisture-resistant disposable bag

SAFETY

1. Infants and children unable to notify others of distress

must be observed at all times.

2. The child, when transported outside of the client room,

must be accompanied by trained personnel.

3. Initiate “Code Blue” and provide resuscitation if child

experiences respiratory failure.

4. The following items must accompany the child when

leaving the room: self-inflating resuscitation bag, mask,
suction catheter, connecting tubing, normal saline,
stethoscope, portable oxygen, and suction setup.

5. Be alert to complications including obstruction, hemor-

rhage, subcutaneous emphysema, tube dislodgement.

PROCEDURE

1. Wash hands. Reduces transmission of microorganisms.
2. Prepare child and family for procedure. Consider having

someone support or comfort the child. Enhances coop-
eration and parental participation and reduces anxiety
and fear.

3. Assess patency of airway, ETT placement (note the cen-

timeter marking), size, security of ETT, proper humidi-
fication to airway, level of consciousness every 2 hours
(more frequent as determined by physician’s order or
assessment). Include respiratory rate, work of breathing
(retractions, flaring, grunting), breath sounds, chest
symmetry, color, oxygen saturation. Monitor cardiorespi-
ratory monitor and pulse oximeter. Identify ventilator
settings and verify physician’s orders regarding oxygen
concentration, humidity, air temperature, pressure, tidal
volume, and inspiratory/expiratory ratio and rate.
Support the ventilator tubing by securing to bed.

4. Position child to prevent airway occlusion and promote

secretion drainage.

5. Monitor security of ETT. If tape loosens and ETT

appears to not be secured, resecure (with assistance as
needed).

6. If it is necessary to completely retape ETT, gently

remove hypoactive dressings while assistant secures
ETT. Tear two pieces of tape long enough to reach from
one cheek to the other. Split each piece of tape approxi-
mately

2

/

3

of its length. Paint each cheek and above the

mouth over the nasal philtrum with benzoin. Affix the
hypoactive dressing on each cheek after the benzoin is
dry (tacky). Place the unsplit end of the tape to the
square of hypoactive dressing. Carry the upper split por-
tion of the tape over the nasal philtrum onto the oppo-
site cheek. Bring the lower split end of the tape under
the tube and wrap in a spiral. Fold the last 5 mm of the
tail onto itself. Affix the second split tape in the same
manner.

7. Auscultate breath sounds and observe chest expansion.

Record length of the ETT. Observe for air leaks. Ensure
ventilator is securely attached to ETT. Suction as
needed.

8. Assist in obtaining chest X ray to check placement of

ETT if there is concern regarding displacement.

9. Insert nasogastric tube if one is not already placed.

(Follow procedures described earlier.) To prevent aspi-
ration of stomach contents, abdominal distention due to
positive pressure ventilation, and prevent air trapping.

10. Measure arterial blood gases according to physician’s

orders. Assess hydration status in relation to viscosity of
secretions. Note heated humidity, medications, skin tur-
gor, mucous membranes, intake and output.

11. Provide oral care bid or more frequently as needed.

109

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 50

SKILL 50

Endotracheal Tube Monitoring (ETT)

continued

12. Assess means and effectiveness of communicating daily

needs (acutely and long term). Provide alternative meth-
ods as needed, e.g., eye blinks, tapping on bed, paper
and pencil.

13. Promote ongoing nutrition needs.
14. Assess ongoing psychosocial needs of child and family

coping with endotracheal tube.

15. Assess developmental needs.

DOCUMENTATION

1. Child’s general condition. Results of chest X ray (CXR)

and ABGs as applicable.

2. Client assessment, with a focus on respiratory status,

e.g., respiratory rate, effort, color, breath sounds, chest
movement, oxygen saturation, ventilator settings, pres-
ence of air leaks.

3. Note size, centimeter marking, and security of ETT.
4. Identify patency of nasogastric tube and amount of

drainage.

5. Cares child receives, e.g., oral care, repositioning.
6. Child’s response to nursing cares.

110

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 50

SKILL 50

Endotracheal Tube Monitoring (ETT)

continued