Care of the Client with an Artificial Airway

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Transcript 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%
Partial Rebreather mask
 60-75%
Simple Face mask
 40-60%
Non Rebreather mask
 80-95%
High Flow Oxygen Delivery System
Venturi mask
 24-55%
Aerosol mask, face tent, Tracheostomy collar
 24-100%
T piece
 24-100% FIO2 (10L/min)
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
► Heimlich
► Cricoidthyroidectomy
► Endotracheal
► Tracheostomy
Proper Placement of Artificial
► Nasopharyngeal-
inserted through
the nares
terminating into
the oropharynx
Endotracheal Intubation
► Oro-pharyngeal-inserted
from the mouth
past the uvula into the oral pharynx
-A surgical incision in the trachea (windpipe) below the larynx
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
Types of Tracheostomy tubes
► Single
► Double Lumen
► Cuffed
► Cuffless
► Fenestrated
► Cuffed fenestrated
► Metal
► Talking
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
► Frequent oral care
► Maintain sterile technique
► Anchor securely
Nursing Considerations
► Nursing
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
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
Monitoring Cuff Pressure
► Monitor
cuff pressure closely
► Maintain cuff pressure of 14- 20 mmHg or 2028 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
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
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
Complications of Artificial Airways
► Trauma –pneumothorax, subcutaneous emphysema
► Bleeding
► Cardiac dysrhythmias► Cardiac and respiratory arrest-tube
► Death
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