Respiratory therapists (RTs) play a crucial role in the healthcare system, providing essential care to patients with breathing difficulties.
One of the critical tasks often associated with respiratory therapists is intubation—a procedure involving the insertion of a tube into a patient’s airway to maintain an open airway, facilitate mechanical ventilation, or administer anesthetic gases.
Whether RTs are responsible for performing intubation can vary based on the healthcare setting, state regulations, and the specific training.
This article explores the scope of practice for respiratory therapists regarding intubation and how it fits into their broader role in patient care.
Can Respiratory Therapists Intubate?
Yes, respiratory therapists are highly skilled professionals who are licensed and trained to intubate patients. This skill is within their scope of practice, and respiratory therapists can perform the procedure in both elective and emergency situations.
Intubation requires specialized training and expertise, and RTs undergo rigorous education to acquire the necessary skills for this critical task.
Their training includes knowledge of anatomy and physiology, as well as hands-on experience with airway management. As a result, respiratory therapists are often key members of the healthcare team when it comes to managing patients who require mechanical ventilation or airway stabilization.
Note: While respiratory therapists’ specific duties can vary depending on state regulations and institutional policies, intubation is generally recognized as part of their role in many healthcare settings.
What is Intubation?
Intubation is a medical procedure that involves inserting a flexible tube, known as an endotracheal tube, into a patient’s trachea (windpipe) through the mouth or nose. The primary purpose of intubation is to maintain an open airway, facilitate mechanical ventilation, or deliver anesthetic gases during surgery.
This procedure is commonly performed in emergency situations where a patient is unable to breathe on their own, as well as during planned surgeries requiring general anesthesia.
Intubation is a critical intervention that ensures the airway remains unobstructed and allows healthcare professionals to control a patient’s breathing.
The process involves several steps, including the proper positioning of the patient, visualization of the vocal cords using a laryngoscope, and the careful insertion and placement of the tube within the trachea. Once in place, the tube is secured, and the patient can be connected to a ventilator for breathing support.
What Equipment is Required for Intubation?
A successful intubation requires careful preparation and the right equipment. Here is a list of essential items needed for intubation:
- Endotracheal Tubes: Available in multiple sizes to accommodate different patients.
- Personal Protective Equipment (PPE): Including gloves, gowns, masks, and face shields to ensure the safety of both the patient and healthcare provider.
- Oxygen Flowmeter and Delivery Source: To provide supplemental oxygen during the procedure.
- Suction Machine and Vacuum Source: Essential for clearing secretions from the airway.
- Sterile Suction Catheters: For precise suctioning within the trachea.
- Yankauer Tip Suction Catheter: A rigid suction device for clearing the oral cavity.
- Bag-Valve Mask (BVM): To ventilate the patient before and after intubation.
- Colorimetric CO2 Detector: To confirm the correct placement of the endotracheal tube by detecting exhaled carbon dioxide.
- Laryngoscope and Blades: Used to visualize the vocal cords during intubation.
- Stylet: A malleable metal wire to guide the endotracheal tube into the trachea.
- Stethoscope: For auscultating breath sounds and confirming tube placement.
- Tape or Tube Holder: To secure the endotracheal tube once it is in place.
- 10 mL Syringe: For inflating the cuff of the endotracheal tube.
- Magill Forceps: Used for guiding the tube into position in certain cases, especially nasal intubation.
- Water-Soluble Lubricating Gel: To ease the insertion of the endotracheal tube.
The respiratory therapist is responsible for assembling and testing all necessary equipment before intubation, ensuring everything is functioning properly and readily available.
This preparation is crucial for the procedure’s success and for minimizing potential complications during intubation.
Which Medical Professionals Can Perform Intubation?
Intubation is a complex medical procedure that must be performed by trained healthcare professionals.
Only those who have undergone the appropriate training and demonstrated competency should carry out this critical task.
In the United States, the medical professionals licensed to perform intubation include:
- Respiratory Therapists: These professionals are often involved in airway management and are trained to perform intubation in various clinical settings.
- Physicians: Many doctors, particularly those working in emergency medicine, critical care, and surgery, are trained to intubate patients.
- Pulmonologists: Specialists in respiratory disorders who frequently manage airway emergencies and perform intubations.
- Anesthesiologists: Experts in anesthesia and airway management who routinely perform intubation as part of their practice.
- Nurse Anesthetists (CRNAs): Registered nurses with advanced training in anesthesia who are skilled in intubation.
In emergency situations, other medical professionals, such as paramedics and EMTs, may also be trained to perform field intubation, a procedure carried out outside the hospital setting.
In these scenarios, they often use special artificial airways that are easier to insert, such as the King airway or laryngeal mask airway (LMA).
These devices are designed to facilitate quick and effective airway management when conventional intubation is not feasible or when rapid intervention is required.
FAQs About Respiratory Therapists and Intubation
What is an Endotracheal Tube?
An endotracheal tube (ET tube) is a flexible plastic tube that is inserted through the mouth or nose into the trachea to maintain an open airway. The tube is typically connected to a mechanical ventilator, which assists or controls breathing.
Endotracheal tubes are commonly used during surgery, in critical care settings, and during emergency interventions to secure the airway and support the patient’s breathing.
When Does a Patient Need to Be Intubated?
A patient may need to be intubated in various situations where they are unable to maintain an adequate airway or sufficient breathing on their own.
Common scenarios include:
- Respiratory Failure: When a patient cannot breathe adequately to maintain normal blood oxygen and carbon dioxide levels.
- Airway Obstruction: Due to trauma, swelling, foreign bodies, or other causes that block the airway.
- Surgery: Patients undergoing general anesthesia require intubation to ensure a secure airway and controlled ventilation.
- Severe Respiratory Distress: Conditions such as severe asthma attacks, COPD exacerbations, or pneumonia that impair breathing.
- Cardiac Arrest: Intubation may be necessary to secure the airway during resuscitation efforts.
- Coma or Unconsciousness: When a patient’s level of consciousness is too low to protect their airway.
Note: In these cases, intubation is a critical intervention to ensure proper ventilation and oxygenation until the underlying issue can be addressed or resolved.
Can Nurses Intubate?
In most settings, registered nurses (RNs) are not typically authorized to perform intubation. However, some advanced practice nurses, such as nurse anesthetists (CRNAs) and nurse practitioners with specialized training, may be qualified to intubate patients.
These professionals undergo extensive education and training in airway management and are often permitted to perform intubation in certain healthcare settings, particularly in anesthesia and critical care.
What Drugs are Administered for Intubation?
During intubation, several medications may be administered to facilitate the procedure and ensure patient comfort and safety.
The primary classes of drugs used include:
- Sedatives: Medications like propofol, midazolam, or etomidate are used to sedate the patient, reducing anxiety and discomfort during intubation.
- Paralytics: Neuromuscular blocking agents such as succinylcholine or rocuronium are administered to relax the muscles and facilitate easy insertion of the endotracheal tube by preventing gag reflexes and involuntary movements.
- Analgesics: Opioids such as fentanyl may be used to manage pain and discomfort during the procedure.
- Anticholinergics: Medications like atropine can be used in pediatric patients to prevent bradycardia during intubation.
Note: The choice of drugs and their dosages depend on the patient’s condition, age, weight, and other factors. Administering these medications requires careful monitoring and expertise to ensure the patient’s safety.
Do Respiratory Therapists Extubate Patients?
Yes, respiratory therapists are trained and often responsible for extubating patients. Extubation is the process of removing the endotracheal tube once the patient no longer requires mechanical ventilation and can breathe independently.
The procedure involves assessing the patient’s readiness, explaining the process to the patient, and carefully removing the tube while monitoring for complications such as airway obstruction or respiratory distress.
Respiratory therapists play a key role in assessing a patient’s readiness for extubation and providing post-extubation care to ensure a smooth transition to spontaneous breathing.
What Else Can Respiratory Therapists Do?
Respiratory therapists are highly skilled healthcare professionals who perform a wide range of duties beyond intubation and extubation.
Their responsibilities include:
- Conducting Pulmonary Function Tests: Assessing lung function and diagnosing respiratory conditions.
- Administering Therapeutic Modalities: Providing treatments such as aerosolized medications, chest physiotherapy, and airway clearance techniques.
- Managing Ventilators: Setting up and adjusting mechanical ventilators for patients in critical care settings.
- Performing Patient Assessments: Monitoring respiratory status and vital signs, and making recommendations for treatment adjustments.
- Educating Patients and Families: Teaching patients how to use respiratory equipment and manage chronic respiratory conditions at home.
- Participating in Emergency Care: Assisting in resuscitation efforts and providing rapid response in emergency situations.
Note: Respiratory therapists work in various healthcare settings, including hospitals, clinics, and home care, collaborating with physicians and other healthcare providers to deliver comprehensive respiratory care.
Final Thoughts
Respiratory therapists are integral to the healthcare team, providing critical support in airway management, intubation, and extubation.
Their extensive training and expertise enable them to perform intubation and other essential procedures safely and effectively.
By collaborating with physicians, anesthesiologists, and other healthcare professionals, respiratory therapists ensure that patients receive comprehensive care tailored to their specific needs.
Understanding the capabilities and scope of practice of respiratory therapists not only highlights their value in the healthcare system but also underscores the importance of their role in improving patient outcomes and maintaining airway management standards.
Written by:
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Miller AG, Gentile MA, Coyle JP. Respiratory Therapist Endotracheal Intubation Practices. Respir Care. 2020.