When a person dies while on a ventilator or is intubated, the endotracheal tube used for intubation is often left in place after death has been declared. There are several reasons why healthcare providers may choose to leave the intubation tube in situ rather than removing it immediately.
To Maintain an Open Airway
One of the main reasons to leave an endotracheal tube in place after death is to maintain an open airway. The tube helps keep the airway patent and prevents the tongue from obstructing the throat. This can be especially important if the body will be transported or subject to a post-mortem examination. Removing the tube can allow the tongue to fall back and block the airway before stiffness sets in.
Keeping the airway open with an intubation tube also prevents secretions from accumulating in the throat and lungs. Buildup of fluids can lead to gurgling sounds or leakage from the nose and mouth as the body decomposes. This can be distressing for family members if they are spending time with the deceased before funeral arrangements.
Facilitate Body Handling
Leaving the endotracheal tube in place can make it easier to handle and maneuver the body after death. The tube helps maintain the stability and position of the head and neck. It also allows funeral home staff or morgue technicians to easily reposition the body without disturbing the airway or causing unsettling noises from the throat.
In some cases, the tube is left during transport of the body from the hospital to funeral home. This prevents airway issues or leaks that could occur in transit.
Aid in Hygienic Prep
Funeral homes often perform hygienic preparation and cleaning of the body before burial or cremation. Having the endotracheal tube in place during this process can make it simpler to suction and drain fluids from the lungs. Removing accumulated lung secretions prevents purge or leakage from the nose and mouth later on.
The tube also allows embalming fluids or sealants to be injected directly into the trachea and lungs. This allows more uniform distribution of preservatives for intact bodies.
Facilitate Identification
If the deceased’s identity is unknown or the death is part of a criminal investigation, the endotracheal tube may be left in to assist with identification. Police, medical examiners, and forensic technicians can use the tube as a landmark when photographing or examining the face and throat. This provides clear visual evidence of intubation and the condition of the airway.
In severe trauma cases, keeping the tube in place also maintains the anatomical relationships in the neck in case there is underlying damage to structures like the larynx or cervical spine.
Allow Time for Family Adjustment
For loved ones keeping vigil over the body before funeral services, seeing an endotracheal tube can be distressing. Some families wish to take time to process the death before removing medical interventions. Keeping the tube in briefly allows family members to make emotional adjustments and avoids rushing procedures.
Adhere to Family Preferences
Some family members may request that no changes be made to the body until other next-of-kin can view the deceased. They may ask for religious reasons that the endotracheal tube remain in place until after certain customs or rituals are performed. Their wishes for the handling of the body are generally respected.
Prevent Bad Outcomes
If the endotracheal tube is removed improperly or the airway collapses, it can lead to an undignified post-mortem appearance. Fluids may leak from the nose or mouth and the facial features can become distorted. Keeping the tube in until later prevents this outcome and avoids causing further distress to the grieving family.
Allow Time to Obtain Consent
Before removing an endotracheal tube or any other medical intervention after death, informed consent is usually required from the next-of-kin. Keeping the tube in place allows time for providers to have sensitive discussions with family members and obtain the necessary permissions.
Conclusion
Leaving an endotracheal tube in place after someone dies serves important functions. It maintains an open protected airway, allows proper body handling, assists funeral home preparation, and prevents distressing post-mortem changes. Respecting the wishes of grieving family members regarding removal of medical interventions is also a high priority. With care and sensitivity, healthcare providers can explain the reasons for leaving in or removing the intubation tube based on the circumstances of each situation.
