Care of the Client Care of the Client with an Artificial with an Artificial

Airway Airway

NURS 108NURS 108

Essex County CollegeEssex County CollegeMajuvy L. Sulse MSN,RN, CCRNMajuvy L. Sulse MSN,RN, CCRN

Low Flow Oxygen Delivery SystemLow Flow Oxygen Delivery System

► Nasal cannulaNasal cannula 24-44% 24-44% FIO2FIO2 (1-6L/min) (1-6L/min)

► Simple Face maskSimple Face mask 40-60% 40-60% FIO2FIO2 (5-8L/min) (5-8L/min)

► Partial Rebreather maskPartial Rebreather mask 60-75% 60-75% FIO2 FIO2 (6-11L/min)(6-11L/min)

► Non Rebreather maskNon Rebreather mask 80-95% 80-95% FIO2FIO2 (10-15L/min) (10-15L/min)

High Flow Oxygen Delivery High Flow Oxygen Delivery SystemSystem

► Venturi maskVenturi mask 24-55% 24-55% FIO2FIO2 (4-10L/min) (4-10L/min)

► Aerosol mask, face tent, Tracheostomy collarAerosol mask, face tent, Tracheostomy collar 24-100% 24-100% FIO2FIO2 (10/min) (10/min)

► T piece T piece 24-100% F24-100% FIO2IO2 (10L/min) (10L/min)

Indications for use of Artificial Indications for use of Artificial AirwaysAirways

►Partial or Complete airway obstructionPartial or Complete airway obstruction Aspiration from food or foreign bodyAspiration from food or foreign body Laryngeal edema post intubationLaryngeal edema post intubation CNS depression from sedatives & CNS depression from sedatives &

narcotics narcotics Head trauma or neck injuryHead trauma or neck injury Allergic reactions Allergic reactions

InterventionsInterventions

► Heimlich maneuverHeimlich maneuver► CricoidthyroidectoCricoidthyroidecto

mymy► Endotracheal Endotracheal

intubationintubation► TracheostomyTracheostomy

Proper Placement of Artificial Proper Placement of Artificial AirwaysAirways

Endotracheal Endotracheal IntubationIntubation

► Nasopharyngeal-Nasopharyngeal-inserted through inserted through the nares the nares terminating into terminating into the oropharynxthe oropharynx

Endotracheal IntubationEndotracheal Intubation

► Oro-pharyngeal-inserted from the mouth Oro-pharyngeal-inserted from the mouth past the uvula into the oral pharynxpast the uvula into the oral pharynx

TracheostomyTracheostomy-A surgical incision in the trachea (windpipe) below the larynx

Advantages of TracheostomyAdvantages of Tracheostomy

►Bypass an upper airway obstructionBypass an upper airway obstruction►Facilitate removal of secretionsFacilitate removal of secretions►Permit long term mechanical Permit long term mechanical

ventilationventilation►Permit oral intake & speechPermit oral intake & speech►Less risk of airway damageLess risk of airway damage►Permit mobility & comfortPermit mobility & comfort

Types of Tracheostomy tubesTypes of Tracheostomy tubes

►Single LumenSingle Lumen►Double LumenDouble Lumen►CuffedCuffed►CufflessCuffless►FenestratedFenestrated►Cuffed fenestratedCuffed fenestrated►MetalMetal►TalkingTalking

Nursing ConsiderationsNursing Considerations

► PositionPosition► Side lying or semi prone position to prevent Side lying or semi prone position to prevent

aspiration of oral secretions unless aspiration of oral secretions unless contraindicatedcontraindicated

► HOB elevated 30-45 degreesHOB elevated 30-45 degrees

► Endotrach/Trach careEndotrach/Trach care► Suction secretions as needed-(no longer Suction secretions as needed-(no longer

than 10-15 sec)than 10-15 sec)► Pressure at wall suction unit between 100-Pressure at wall suction unit between 100-

120 mmHg120 mmHg► Frequent oral careFrequent oral care► Maintain sterile techniqueMaintain sterile technique► Anchor securelyAnchor securely

Nursing ConsiderationsNursing Considerations

►Nursing careNursing care Assess respiratory rate, rhythm, & depthAssess respiratory rate, rhythm, & depth Assess respiratory status every 4 hours or Assess respiratory status every 4 hours or

moremore Assess level of consciousness and skin Assess level of consciousness and skin

colorcolor Provide notepad or picture boardProvide notepad or picture board

Tube maintenance & Tube maintenance & anchoringanchoring

►Secure tube to prevent accidental Secure tube to prevent accidental extubation/tube displacementextubation/tube displacement

►Assess position of tube frequentlyAssess position of tube frequently►Use restraints, sedatives, Use restraints, sedatives,

neuromuscular blocking agents if neuromuscular blocking agents if agitated/restlessagitated/restless

►Notify physician immediately if tube is Notify physician immediately if tube is dislodgeddislodged

Monitoring Cuff PressureMonitoring Cuff Pressure

► Monitor cuff pressure closelyMonitor cuff pressure closely► Maintain cuff pressure of 14- 20 mmHg or Maintain cuff pressure of 14- 20 mmHg or

20-28 cm H2020-28 cm H20► Minimal leak technique (MLT)-withdrawing Minimal leak technique (MLT)-withdrawing

0.1 ml of air after inflating cuff with 0.1 ml of air after inflating cuff with minimal air. Is a risk for aspiration of minimal air. Is a risk for aspiration of secretions.secretions.

► Occlusive techniqueOcclusive technique

Oxygen therapyOxygen therapy

► Provide humidified oxygenProvide humidified oxygen► Administer 100% oxygen via Administer 100% oxygen via

ETT/Trach prior to suctioningETT/Trach prior to suctioning► If on mechanical ventilation all If on mechanical ventilation all

alarms are enabled at all timesalarms are enabled at all times► Ambubag should always be Ambubag should always be

available at the bedsideavailable at the bedside► Sterile suction catheters at Sterile suction catheters at

bedsidebedside

Tracheostomy Care & HygieneTracheostomy Care & Hygiene

►Obturator at head of bed at all timesObturator at head of bed at all times►Sterile technique especially for open Sterile technique especially for open

suctionsuction►Stoma care-assess for s/s of infectionStoma care-assess for s/s of infection►Hand washing always important Hand washing always important

Complications of Artificial Complications of Artificial AirwaysAirways

► InfectionInfection► Trauma –pneumothorax, subcutaneous Trauma –pneumothorax, subcutaneous

emphysemaemphysema► BleedingBleeding► Cardiac dysrhythmias-Cardiac dysrhythmias-► Cardiac and respiratory arrest-tube Cardiac and respiratory arrest-tube

obstruction/dislodgementobstruction/dislodgement► DeathDeath

Nursing responsibilities for Nursing responsibilities for discharge or community caredischarge or community care

► Teach both client & caregiver importance of Teach both client & caregiver importance of tracheal caretracheal care

► Assess level of understanding & observe Assess level of understanding & observe return demonstration of tracheal care & return demonstration of tracheal care & suctioningsuctioning

► Stress the importance of good hand hygiene Stress the importance of good hand hygiene especially when cleaning tracheostomy tubeespecially when cleaning tracheostomy tube

► Signs & symptoms of infection especially at Signs & symptoms of infection especially at stoma sitestoma site

► Provide name & number of health care Provide name & number of health care personnel to be contacted for advice or in personnel to be contacted for advice or in emergency situationsemergency situations

► Need for increase hydrationNeed for increase hydration