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
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Nasal cannula
 24-44%
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FIO2
(5-8L/min)
Partial Rebreather mask
 60-75%
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(1-6L/min)
Simple Face mask
 40-60%
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FIO2
FIO2
(6-11L/min)
Non Rebreather mask
 80-95%
FIO2
(10-15L/min)
High Flow Oxygen Delivery System
►
Venturi mask
 24-55%
►
FIO2
Aerosol mask, face tent, Tracheostomy collar
 24-100%
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(4-10L/min)
FIO2
(10/min)
T piece
 24-100% FIO2 (10L/min)
Indications for use of Artificial Airways
► Partial
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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
Interventions
► Heimlich
maneuver
► Cricoidthyroidectomy
► Endotracheal
intubation
► Tracheostomy
Proper Placement of Artificial
Airways
Endotracheal
Intubation
► Nasopharyngeal-
inserted through
the nares
terminating into
the oropharynx
Endotracheal Intubation
► Oro-pharyngeal-inserted
from the mouth
past the uvula into the oral pharynx
Tracheostomy
-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
Lumen
► 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
mmHg
► Frequent oral care
► Maintain sterile technique
► Anchor securely
Nursing Considerations
► Nursing
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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
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
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
Infection
► Trauma –pneumothorax, subcutaneous emphysema
► Bleeding
► Cardiac dysrhythmias► Cardiac and respiratory arrest-tube
obstruction/dislodgement
► Death
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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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