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Lesson

Post-Intubation Care

12 min Airway & Breathing Skip to quiz

Objective: After the tube is in, confirm the waveform, control the bag rate, watch the blood pressure, and secure the tube so a move does not undo the pass.

Why this matters

Teams celebrate the tube, then lose it while packaging. They bag too fast and drop the blood pressure. Or they miss an esophageal tube because they checked only once. Care after the tube is half of the airway job.

Verbalize
  • I confirm with a continuous waveform. End-tidal carbon dioxide (EtCO₂) is that carbon dioxide trace on the monitor.
  • I secure the tube and I say the depth at the teeth or gums.
  • I do not bag fast. I check the waveform again after every major move.

Clinical sequence

  1. Confirm first. Use the continuous waveform, breath sounds on both sides, and chest rise. If something is wrong, fix displacement, obstruction, pneumothorax, or equipment now. A sudden flat waveform is an emergency until you prove otherwise. Think a moved tube, arrest, or a disconnected circuit.
  2. Secure the tube with a commercial holder, or the method in your training. Write the centimeter mark at the teeth or gums, and check it again after you move them.
  3. Do not hyperventilate. A common adult teaching rate with an advanced airway is about 10 breaths per minute, with visible chest rise. After return of spontaneous circulation, aim for a normal carbon dioxide range per protocol. Do not bag the waveform number down into the 20s.
  4. Use a high oxygen fraction until a reliable sat is on the monitor, then titrate. After arrest, aim for about 90–98% once the number is real. Follow your protocol.
  5. Watch the blood pressure. Positive pressure can drop it. Be ready per protocol. Use fluids or a vasopressor only if you are authorized.
  6. If your system continues sedation and pain control, know when it is indicated and how you will monitor. Do not improvise a plan.
  7. Confirm again on the stretcher, in the ambulance, and in the hospital bay.

In practice

  • A mainstem tube shows breath sounds on one side and a bag that is hard to squeeze. Pull it back carefully, per your training.
  • Place a gastric tube, through the nose or the mouth, only if your protocol and training support it to lower aspiration risk.

Common errors

  • Checking a color-change detector once and never using a continuous waveform.
  • Taping the tube loosely, then rolling the patient.
  • Bagging a patient who has a pulse as if you were in a cardiac-arrest practice station.

Practice

One-minute check

After the tube, say this in order: confirm with the waveform, secure the tube and state the depth, state the ventilation rate, check the blood pressure, and say you will confirm again after the move. Your partner then rolls the stretcher and the EtCO₂ trace goes flat. Start DOPE immediately.

Related: DOPE-S, Waveform capnography.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. The first job after the tube is in is:
2. Sudden loss of EtCO₂ waveform after a move should prompt:
3. Hyperventilation after intubation can:
4. Tube depth at the teeth or gums should be:
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