Extubation criteria

Extubation criteria

· return to adequate conscious state

· gag and cough reflex

· normothermia

· haemodynamic stability

· stable metabolic parameters

· premorbid gaseous exchange on FiO 2 <>

· adequate respiratory mechanics

· adequate cuff leak around deflated ETT

· all patients must have supplemental O2 post extubation

Extubation procedure

For safe extubation the patient needs to meet the above criteria. Once you have established this proceed with extubation. (to be undertaken by registered nurses with a post basic qualification in cardiac or intensive care nursing or those undertaking the graduate diploma under the direct supervision of an accredited registered nurse).

Ensure that you have all necessary equipment (hand ventilating assembly, high pressure suction, yancker sucker, size 12 suction catheters x 2, 10 cc syringe, scissors, CIG mask and tubing, tissues and blue disposable towel)

Patients are frequently anxious throughout the procedure so that a confident, caring manner is essential. A good principle to follow is to wean and extubate patients from mechanical ventilation at the earliest instance. Weaning for prolonged periods and delaying extubation unnecessarily adds to an already stressful postoperative experience. Weaning is an interactive process with the nurse providing gentle coaching and reassurance as well close clinical supervision. The weaning and extubation experience is favourably mediated by the clinician.

· ensure that you have all the necessary equipment

· place patient on the hand ventilating bag (10 l / m flow)

· remove the inline trachcare suction

· remove all secretions from the oropharynx using the yancker sucker and a gentle technique

· cut tapes holding ETT

· deflate the ETT cuff and while administering a breath via the hand ventilating bag listen for air leak around the deflated cuff

· pass a size 12 suction catheter down the ETT until patient coughs, withdraw 1cm, apply suction and remove the ETT and the catheter in a smooth, non hurried manner

· instruct the patient to cough and remove any secretions into a tissue

· place patient on supplemental oxygen via the CIG mask at 10l

· observe the patient closely for laryngeal stridor and monitor saturations

· monitor vital signs 15 minutely for one hour and repeat arterial blood gas

Do not administer narcotics in the first hour post extubation.

The nurse’s role is more then just manipulating the technological support and observing patients’ physiological responses but also enhancing conditions which affect their weaning performance such as energy, comfort, information and trust.