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Care of the Client with an Artificial Airway

Care of the Client with an Artificial Airway . NURS 108 Essex County College Majuvy L. Sulse MSN,RN, CCRN. Low Flow Oxygen Delivery System. Nasal cannula 24-44% FIO2 (1-6L/min) Simple Face mask 40-60% FIO2 (5-8L/min) Partial Rebreather mask 60-75% FIO2 (6-11L/min)

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Care of the Client with an Artificial Airway

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  1. Care of the Client with an Artificial Airway NURS 108 Essex County College Majuvy L. Sulse MSN,RN, CCRN

  2. Low Flow Oxygen Delivery System • Nasal cannula • 24-44% FIO2 (1-6L/min) • Simple Face mask • 40-60% FIO2 (5-8L/min) • Partial Rebreather mask • 60-75% FIO2 (6-11L/min) • Non Rebreather mask • 80-95% FIO2 (10-15L/min)

  3. High Flow Oxygen Delivery System • Venturi mask • 24-55% FIO2 (4-10L/min) • Aerosol mask, face tent, Tracheostomy collar • 24-100% FIO2 (10/min) • T piece • 24-100% FIO2 (10L/min)

  4. Indications for use of Artificial Airways • Partial or Complete airway obstruction • Aspiration from food or foreign body • Laryngeal edema post intubation • CNS depression from sedatives & narcotics • Head trauma or neck injury • Allergic reactions

  5. Interventions • Heimlich maneuver • Cricoidthyroidectomy • Endotracheal intubation • Tracheostomy

  6. Proper Placement of Artificial Airways Endotracheal Intubation • Nasopharyngeal-inserted through the nares terminating into the oropharynx

  7. Endotracheal Intubation • Oro-pharyngeal-inserted from the mouth past the uvula into the oral pharynx

  8. Tracheostomy -A surgical incision in the trachea (windpipe) below the larynx

  9. Advantages of Tracheostomy • Bypass an upper airway obstruction • Facilitate removal of secretions • Permit long term mechanical ventilation • Permit oral intake & speech • Less risk of airway damage • Permit mobility & comfort

  10. Types of Tracheostomy tubes • Single Lumen • Double Lumen • Cuffed • Cuffless • Fenestrated • Cuffed fenestrated • Metal • Talking

  11. Nursing Considerations • Position • Side lying or semi prone position to prevent aspiration of oral secretions unless contraindicated • HOB elevated 30-45 degrees • Endotrach/Trach care • Suction secretions as needed-(no longer than 10-15 sec) • Pressure at wall suction unit between 100-120 mmHg • Frequent oral care • Maintain sterile technique • Anchor securely

  12. Nursing Considerations • Nursing care • Assess respiratory rate, rhythm, & depth • Assess respiratory status every 4 hours or more • Assess level of consciousness and skin color • Provide notepad or picture board

  13. Tube maintenance & anchoring • Secure tube to prevent accidental extubation/tube displacement • Assess position of tube frequently • Use restraints, sedatives, neuromuscular blocking agents if agitated/restless • Notify physician immediately if tube is dislodged

  14. Monitoring Cuff Pressure • Monitor cuff pressure closely • Maintain cuff pressure of 14- 20 mmHg or 20-28 cm H20 • Minimal leak technique (MLT)-withdrawing 0.1 ml of air after inflating cuff with minimal air. Is a risk for aspiration of secretions. • Occlusive technique

  15. Oxygen therapy • Provide humidified oxygen • Administer 100% oxygen via ETT/Trach prior to suctioning • If on mechanical ventilation all alarms are enabled at all times • Ambubag should always be available at the bedside • Sterile suction catheters at bedside

  16. Tracheostomy Care & Hygiene • Obturator at head of bed at all times • Sterile technique especially for open suction • Stoma care-assess for s/s of infection • Hand washing always important

  17. Complications of Artificial Airways • Infection • Trauma –pneumothorax, subcutaneous emphysema • Bleeding • Cardiac dysrhythmias- • Cardiac and respiratory arrest-tube obstruction/dislodgement • Death

  18. Nursing responsibilities for discharge or community care • Teach both client & caregiver importance of tracheal care • Assess level of understanding & observe return demonstration of tracheal care & suctioning • Stress the importance of good hand hygiene especially when cleaning tracheostomy tube • Signs & symptoms of infection especially at stoma site • Provide name & number of health care personnel to be contacted for advice or in emergency situations • Need for increase hydration

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