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Artificial Airways & Airway Management

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Presentation on theme: "Artificial Airways & Airway Management"— Presentation transcript:

1 Artificial Airways & Airway Management

2 Effective Cough Components Adequate vital capacity (VC > 15 mL/kg)
Abdominal contraction Glottic closure

3 Phases of a Cough Irritation of airway Inspiration of adequate volume
Compression Glottic closure Contraction of abdominal muscles Increase in intrathoracic pressure

4 Phases of a Cough Expulsion Opening of glottis
Explosive expulsion of air and matter (flow up to 500 mph)

5 Ineffective Cough Inadequate vital capacity Inadequate compression
Inadequate abdominal contraction Inability to close glottis

6 Suctioning Suctioning is the application of negative pressure to the airways through a collecting tube

7 Suctioning Suctioning of the trachea and bronchi is usually done through an endotracheal tube or tracheostomy tube

8 Indications for Suctioning
Need to remove retained secretions Need to maintain patency of airway To treat atelectasis To obtain of a sputum specimen

9 Hazards of Suctioning Trauma Hypoxia Arrhythmias
Inadequate cerebral oxygenation

10 Hazards of Suctioning Infection Vagal stimulation Atelectasis

11 Hazards of Suctioning Bronchospasm Increase in intracranial pressure
Gag reflex stimulation

12 Equipment Required For Suctioning
Oral suctioning Negative pressure source Suction canister Connective tubing

13 Equipment Required For Oral Suctioning
Yankauer (tonsil tip) Suction tip Distilled water or saline solution in container Gloves

14 Equipment Required For Suctioning
Nasal and tracheal suctioning Negative pressure source Suction canister Connective tubing Suction catheter

15 Nasal & Tracheal Suctioning Equipment
Water soluble gel (for nasal suction) Distilled water or saline solution in container Gloves

16 Catheter Types Whistle tip Argyle Coudé Closed catheter systems

17 Suction Catheters Catheter sizes Murphy eye
Measured in French (French/3.14 = size in mm) Diameter of catheter < ½ diameter of tube Murphy eye

18 Pressure During Suctioning
Adult – -100 to -120 mmHg Child – -80 to -100 mmHg Infant – -60 to -80 mmHg

19 Suctioning Procedure Gather equipment, identify patient, introduce self, explain procedure, and wash hands Don gloves, prepare equipment

20 Suctioning Procedure Hyperoxygenate the patient, as appropriate
If suctioning nasally, lubricate the catheter

21 Suctioning Procedure Introduce the catheter into the airway, ensuring that no suction is applied during introduction Advance the catheter until resistance is met

22 Suctioning Procedure Withdraw the catheter 1 to 2 cm
Apply suction continuously, withdraw catheter, rotating catheter during withdrawal (NOTE: apply suction for a maximum of 15 seconds)

23 Suctioning Procedure Rinse the catheter in saline or distilled water
Reassess the patient

24 Artificial Airways Oropharyngeal airway
Used in unconscious patients only to avoid gag reflex Prevents tongue from occluding airway

25 Oropharyngeal Airway Allows passage of suction catheter through center or along the side of airway

26 Oropharyngeal Airway Insertion procedure
Airway is upside down as it is inserted into mouth Rotate sideways as airway passes over tongue Place in correct position once past tongue

27 Artificial Airways Nasopharyngeal airway
Used in conscious patients requiring frequent suctioning Length of airway equals length from nostril to ear plus one inch

28 Nasopharyngeal Airway
Prevents tongue from occluding airway Change from naris to naris as required

29 Nasopharyngeal Insertion Procedure
Lubricate airway with water soluble gel Examine nares; if available, choose nares with smaller opening

30 Nasopharyngeal Insertion Procedure
Gently insert airway, avoiding forcing past obstructions Tip of airway should be visible just past uvula

31 Artificial Airways Endotracheal tubes

32 Endotracheal Tubes Specifications established by the American Society for Testing and Materials (ASTM)

33 Endotracheal Tube Marking
I.T. – Implant tested I.D. – Inner diameter O.D. – Outer diameter

34 Endotracheal Tube Marking
Z-79 – meets standards of that committee for non-toxicity Radiopaque line – determine position after placement Centimeter markings to indicate depth of placement

35 Endotracheal Tube Type
Cuffed Uncuffed Double lumen Jet ventilation

36 Indications for Intubation
Maintain airway patency Prevent aspiration Cardiopulmonary arrest

37 Indications for Intubation
Establishment/maintenance of mechanical ventilation Bronchial hygiene

38 Physiologic Effects of Intubation
Decrease in VD (approximately by ½) If tube is too small, may increase resistance and work of breathing

39 Equipment Needed for Intubation
Suction equipment Laryngoscope Macintosh blade – curved Miller blade – straight

40 Equipment Needed for Intubation
Stylet – only for oral intubation Magill forceps – only for nasotracheal intubation Oropharyngeal airway

41 Equipment Needed For Intubation
Syringe Tape or other securing equipment Endotracheal tube – choice of sizes to meet unexpected conditions

42 Equipment Needed for Intubation
Topical anesthetics (lidocaine, xylocaine) – may be required Paralyzing agents (Pavulon, succinylcholine) – for combative patients

43 Intubation Procedure Assemble and check all equipment
Ensure patient is hyperoxygenated and hyperventilated, if possible Determine desired endotracheal tube size, lubricate with topical anesthetic, if required; insert stylet for oral intubation

44 Intubation Procedure Pre-oxygenate the patient
Position patient in “sniffing” position, if possible Administer paralyzing agent, if required

45 Intubation Procedure Insert laryngoscope Visualize the vocal cords
Insert endotracheal tube between vocal cords

46 Intubation Procedure Inflate the cuff
Check breath sounds; adjust position of endotracheal tube as needed Note and record centimeter mark at the teeth

47 Intubation Procedure Secure the endotracheal tube
Insert oropharyngeal airway Obtain chest X-ray to ensure proper tube placement Check cuff pressure

48 Intubation Hazards Intubation of the esophagus
Trauma to the vocal cords or trachea Tracheal malacia, necrosis, T-E fistula Aspiration Fracture of teeth

49 Tracheostomy Tubes

50 Indications for Tracheotomy
Long term ventilation Provide patent airway when upper airway is impassable

51 Hazards of Tracheotomy
Trauma – laryngeal lesions, tracheal lesions Hemorrhage

52 Hazards of Tracheotomy
Subcutaneous emphysema Infection Tracheal malacia, necrosis, T-E fistula

53 Types of Tracheostomy Tubes
Portex / Shiley Jackson Kamen-Wilkensen Fenestrated

54 Care of The Tracheostomy Tube
Performed as needed according to hospital protocol Assemble and check equipment Gloves and other protective gear Suction equipment Hydrogen peroxide

55 Care of The Tracheostomy Tube
Assemble and check equipment Sterile water Cotton-tipped applicators Pre-cut gauze or 4 x 4 gauze pad Tracheostomy tube ties

56 Care of The Tracheostomy Tube
Suction the patient Remove and clean the inner cannula Clean the stoma site

57 Care of The Tracheostomy Tube
Change the tracheostomy tube ties Re-insert the inner cannula Assess the patient

58 Changing of The Tracheostomy Tube
Performed as needed Perforated cuff Mucus plug Change in size of tube

59 Changing of The Tracheostomy Tube
Assemble and check equipment Gloves and other protective gear New tracheostomy tube Suction equipment Tracheostomy tube ties Resuscitation bag

60 Changing of The Tracheostomy Tube
Pre-oxygenate the patient Suction the patient Remove the tracheostomy tube

61 Changing of The Tracheostomy Tube
Insert the new tube Secure the tracheostomy tube with the ties Assess the patient

62 Management of The Cuff Pressure should be kept between 20 and 25 mmHg

63 Management of The Cuff Techniques for maintaining cuff pressure
Minimal occluding volume Minimal leak technique Direct measurement of cuff pressure by manometer

64 Alternative Airway Devices
Laryngeal mask airway (LMA)

65 Laryngeal Mask Airway (LMA)
Advantages Ease and speed of insertion Avoidance of laryngeal and tracheal trauma Intubation possible without removing LMA

66 Laryngeal Mask Airway (LMA)
Disadvantages Short term use only Cannot provide high ventilation pressures Potential for esophageal injury Aspiration may still occur, although risk is decreased

67 Laryngeal Mask Airway (LMA)
Placement Lubricate posterior surface of the mask Fully deflate cuff Using index finger, guide the insertion along the palate and into the oropharynx Inflate cuff to maximum of 60 cmH2O

68 LMA Placement

69 Alternative Airway Devices
Combitube (Double lumen airway)

70 Combitube Advantages Little skill required for insertion
Protects against aspiration Aids in positive pressure ventilation

71 Combitube Disadvantages Short term use only
Aspiration may occur during removal If placed in esophageal position, cannot suction airway

72 Combitube Disadvantages Potential for esophageal injury
Difficulty in distinguishing between esophageal and tracheal intubation

73 Combitube Placement Insert tube blindly through the oropharynx into the trachea or esophagus Inflate the cuffs

74 Combitube Placement Assess placement of the tube
Ventilate through the appropriate external adapter

75 Combitube Placement

76 Alternative Airway Devices
Tracheal buttons Used to maintain a tracheal stoma

77 Tracheal Buttons Advantages
Removes the airway resistance of a tracheostomy tube Aids in the removal of secretions by allowing continued access when cap is removed Allows patient to communicate verbally, when able

78 Tracheal Buttons Disadvantages
Will not allow attachment of mechanical ventilators Must be removed and replaced with tracheostomy tube in emergency situations

79 Tracheal Buttons Placement
Fits through the skin to just inside the anterior wall of the trachea

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