Endotracheal intubation of the dog and cat
Endotracheal intubation is performed for general anaesthesia, critical care, and emergency situations. As the veterinary surgeon often performs this procedure, it may be under-developed, or minimally practiced by veterinary nurses (VNs) despite being legal to perform in several countries. As an emergency skill, and as the role of VNs grows, this article aims to act as a resource for VNs wanting to learn to perform endotracheal intubation correctly. This article will only review the purpose of endotracheal intubation, the relevant anatomy and physiology, equipment, techniques, and troubleshooting. It will not offer a detailed comparison of endotracheal intubation versus laryngeal mask airway, nor will it discuss the technique for endotracheal tube cuff inflation as the full scope of published data, experiences and opinions could not be given due justice: moreover, this is an area of the skill VNs are already familiar with. Maintenance of the in-situ tube and extubation are also excluded and all of these subjects warrant further discussion in a separate article.
Veterinary nurses (VNs) hold a wide and varied skillset in order to provide the best possible care to their patients. VNs regularly assist with anaesthesia and have many skills in this area, including assisting with the induction of anaesthesia by incremental intravenous agents. Intubation of the trachea is routinely performed immediately after this and because of the positioning of the veterinary surgeon (VS), the VS often performs this skill. For this reason, the skill of endotracheal intubation can be under-developed, or minimally practiced by VNs even though they are legally allowed to perform this skill in the UK. Endotracheal intubation may also need to be performed in an emergency situation, where a VS is not present, as it is a key step of providing cardiopulmonary resuscitation (CPR) and so VNs should be confident to perform this skill (Fletcher et al, 2012). As the advanced VN role develops in the UK, it may be common for VNs to be more involved with anaesthesia induction and the skill of endotracheal intubation may be more regularly required. In some states in the USA veterinary technicians already have a greater role in anaesthesia induction: indeed, nurses must master the skill of endotracheal intubation in order to become credentialed as a Veterinary Technician Specialist (VTS) in Anaesthesia and Analgesia (AVTAA, 2022).