Do respiratory therapists intubate their patients?
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.
In fact, a study analyzed the success rate of intubation attempts performed by respiratory therapists compared to other healthcare providers.
The results showed that respiratory therapists were as successful as anesthesiologists in intubating patients.
What is Intubation?
Intubation is the process of inserting an endotracheal tube through the patient’s mouth or nose into the trachea. This tube is then connected to a mechanical ventilator, which delivers positive pressure to help the patient breathe.
During the intubation procedure, patients are administered anesthesia and muscle relaxants to minimize discomfort during the insertion of the tube.
Indications for Intubation
There are many reasons why a patient may need to be intubated, but the most common indications include:
- Respiratory failure
- Severe respiratory distress
- Severe hypoxemia
- Decreased consciousness
- Change in mental state
- Airway injury
- Airway obstruction
- Risk of aspiration
- Cardiac arrest
- Hemodynamic instability
- Cardiopulmonary resuscitation
Oxygenation and ventilation are required for survival; therefore, there are no true contraindications for intubation and mechanical ventilation.
However, intubation may be difficult in some patients due to their anatomy or underlying medical conditions. In these cases, other considerations must be made to establish an airway, such as a cricothyrotomy.
What Equipment is Needed for Intubation?
A successful intubation attempt requires the use of the right equipment. This includes:
- Endotracheal tubes (multiple sizes)
- PPE (gloves, gowns, masks, face shields, etc.)
- Oxygen flowmeter and delivery source
- Suction machine and vacuum source
- Sterile suction catheters
- Yankauer tip suction catheter
- Bag valve mask
- Colorimetric CO2 detector
- Laryngoscope blade
- Tape or tube holder
- 10 mL syringe
- Magill forceps
- Water-soluble lubricating gel
The respiratory therapist is responsible for assembling and testing the necessary equipment and tools before intubation.
What is an Endotracheal Tube?
An endotracheal tube is a plastic tube that’s inserted through the patient’s mouth or nose and into the trachea. This tube is then connected to a mechanical ventilator, which helps the patient breathe.
ET tubes come in various sizes, and the correct size must be selected for each patient based on their height and weight.
After insertion, the ET tube is secured with tape or a commercial tube holder. This helps establish a link between the patient and the ventilator by maintaining an open airway so that positive-pressure breaths can be delivered.
Drugs Used for Intubation
Several medications may be used during intubation to help with the procedure. Some examples include:
Sedatives are administered to help decrease the patient’s level of consciousness and anxiety. Neuromuscular blocking agents are administered to cause skeletal muscle paralysis and help relax the muscles of breathing.
What Medical Professionals Can Intubate?
Intubation is a medical procedure that must be performed by a trained healthcare professional. Therefore, this skill should only be performed by those who have undergone the proper training and are competent in the procedure.
The medical professionals who are licensed to perform intubation in the United States include:
- Respiratory therapists
- Nurse anesthetists
In emergency situations, other medical professionals such as paramedics and EMTs may be trained to perform field intubation, which is a procedure that takes place outside of the hospital.
In these cases, they often use special artificial airways that are easier to insert, such as a King airway or laryngeal mask airway (LMA).
Can Nurses Intubate?
No, nurses are not licensed or trained to intubate patients. This medical procedure falls outside their scope of practice.
Intubation is a complex skill that should only be performed by respiratory therapists, physicians, pulmonologists, anesthesiologists, and nurse anesthetists.
However, the intubation procedure requires help from an entire team of medical professionals. Therefore, nurses play an important role in the intubation process by providing assistance and support to the physician and medical team.
Job Duties of a Respiratory Therapist
We’ve already established that respiratory therapists can intubate their patients. However, this isn’t the only thing RTs do on the job.
Respiratory therapists generally provide care and treatment to patients with breathing or other cardiopulmonary disorders. They work closely with physicians to develop patient care plans and implement treatment protocols.
Other job duties of respiratory therapists include:
- Assessing patients for lung disease
- Administering aerosol medications to a patient’s lungs
- Administering oxygen therapy
- Administering lung expansion therapy
- Administering chest physical therapy (CPT)
- Administering airway clearance therapy to remove mucus
- Managing patients who are on the mechanical ventilator
- Assisting with endotracheal intubation
- Assisting with a bronchoscopy procedure
- Drawing and analyzing an arterial blood gas (ABG)
- Designing and implementing treatment plans
- Managing patients with a tracheostomy
- Suctioning and analyzing sputum specimens
- Analyzing chest x-rays
- Assessing vital signs
- Performing electrocardiogram tests (ECG)
- Performing pulmonary functions tests (PFT)
- Responding to Code Blue and emergency situations
- Assisting with pulmonary rehabilitation
- Performing studies and research related to the cardiopulmonary system
- Educating patients on smoking cessation
As you can see, respiratory therapists have a wide range of responsibilities. They play an important role in the healthcare system, and their job is vital to the well-being of their patients.
So, back to the original question: Can respiratory therapists intubate their patients? The answer is yes, they absolutely can; and they do.
Respiratory therapists are one of the few healthcare professionals who are licensed and trained to perform this medical procedure. That is because intubation is a complex skill that requires rigorous knowledge and expertise.
Respiratory therapists wear a lot of hats in the hospital. They are more than just someone who can administer breathing treatments. RTs are vital members of the healthcare team who play an important role in saving lives.
Thanks for reading, and, as always, breathe easy, my friend!
John Landry, BS, RRT
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.
Medical Disclaimer: The information provided by Respiratory Therapy Zone is for educational and informational purposes only. It should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition.