Airway Management Flashcards
What is the objective of this module?
To provide a didactic review of the indications, contraindications, complications, and technical approach for the placement of an endotracheal tube and laryngeal mask airway in the neonate.
Why is competency in endotracheal intubation essential?
Competency in performance of endotracheal intubation is an essential skill according to the National Association of Neonatal Nurse Practitioners (NANNP, 2010).
What should all personnel performing endotracheal intubation also be competent in?
Laryngeal Mask Airway placement (AAP/NRP 2011).
List three indications for endotracheal intubation in neonates.
- Respiratory failure
- Need for prolonged positive pressure ventilation
- Relief of critical upper airway obstruction
Are there any absolute contraindications for endotracheal intubation?
No absolute contraindications for intubation.
What physiologic responses can occur during intubation?
- Hypoxia
- Bradycardia
- Intracranial hypertension
- Pulmonary hypertension
What are some complications from inappropriately performed endotracheal intubation?
- Traumatic injury to face, tongue, and gums
- Damage to glottic structures
What characterizes an ideal strategy for neonatal intubation?
- Eliminate pain, discomfort, and physiologic disturbances
- Facilitate expeditious intubation
- Minimize risk for traumatic injury
- Have no adverse effects
Name two approaches to pain management during neonatal intubation.
- Pharmacologic approach to pain management
- Non-pharmacologic measures such as swaddling and comfortable positioning
What equipment should be present for endotracheal intubation?
- Blended oxygen source
- Appropriate size bag and mask
- Endotracheal tubes, stylets, and laryngoscope
- Suction equipment, stethoscope, taping device, CO2 detector
What should all infants have monitored during intubation?
Cardiorespiratory monitoring, oxygen saturation, and blood pressure monitoring.
How should the size of the endotracheal tube (ETT) be determined?
Based on infant weight and gestational age.
What is the depth of insertion for an ETT determined by?
The ‘tip to lip’ rule, measuring the distance from the tip of the ETT to the lip of the infant.
Fill in the blank: The general rule for determining the depth of insertion is to take the infant’s weight in kg and add _______.
6cm
What should be the goal of all caregivers during neonatal intubation?
The alleviation of pain.
In what situations may intubation occur without premedication?
- Initial resuscitation
- After an acute deterioration or critical status
- Some infants with upper airway anomalies, such as Pierre Robin Sequence
What is a key factor in the success of endotracheal intubation?
Appropriate positioning of the neonate.
How should the laryngoscope be held during intubation?
In the left hand with the blade light on and directed towards the patient.
What is the purpose of the laryngoscope blade during intubation?
To lift the epiglottis and visualize the glottis.
What techniques confirm tracheal placement of an ETT?
- Condensation in the ETT tube
- Use of end-tidal CO2 detector
- Auscultation for equal bilateral breath sounds
- CXR as the ‘Gold Standard’
What are some complications from endotracheal intubation?
- Acute trauma such as tracheal or hypopharyngeal perforation
- Hemorrhage
- Laryngeal edema
- Vocal cord injuries
What is a laryngeal mask airway (LMA)?
A specifically designed soft elliptical mask that fits over the laryngeal inlet and is attached to a flexible airway tube.
List two situations where LMA placement may be useful.
- Congenital anomalies where achieving a good seal with a mask is difficult
- Positive pressure ventilation is ineffective and attempts at intubation are unsuccessful
What are contraindications for using a LMA?
- With meconium stained amniotic fluid
- Need for high ventilation pressures
- Very small infants under 2kg
What is the initial step in LMA placement?
Decompress stomach with oral gastric tube as indicated.
How should the infant be positioned for LMA insertion?
In the ‘sniff’ position.
What indicates proper placement of an LMA?
Prompt increase of heart rate and equal breath sounds.
What are potential complications from LMA placement?
- Soft tissue damage
- Laryngospasm
- Gastric distention
