Airway Management and Mechanical Ventilation (ENDOTRACHEAL TUBES ETT) Flashcards
Cranial nerve for cough and gag reflex is
9 and 10
Indications for an Artificial Airway
- upper airway obstructions
- apnea
- high risk for aspiration
- ineffective clearanc of secretions
- respiratory distress
Equipment needed for a Endotracheal Intubation
- Self inflating BVM/ ambu bag and mask and oxygen
- ET tube, guide wire, lubricant, securement device, End Tidal CO2 detector
- Suctioning equipment
- IV access and medications as indicated
Preparation for intubating
- consent/ resuscitation status
- client teaching
- position client
- preoxygenate
Things nurses do during intubation
1.Limit each intubation attempt to less than 30 seconds
2.Ventilate client between successive attempts
3. Rapid sequence intubation (RSI) (administer sedative and Paralytic agents)
4. Monitor oxygenation status
5. Assess for signs of hypoxia, dysrhythmias, aspiration
After intubation you..
- confirm placement of et tube
(a) End-tidal CO2 detector (Gold is good)
(b) Auscultate lung bilaterally
(c) Observe chest wall movement
(d) Check O2 saturation
After placement verification you..
(a) Inflate cuff
(b) Secure airway
(c) Suction oropharynx and ET tube as needed
(d) Obtain chest x-ray (2-6 cm above carina)
(e) Record and mark position of tube in cm at teeth or gums
(f) Monitor oxygen saturation continuously, may monitor end-tidal CO2 continuously
(g) Obtain ABGs as ordered
Mechanical Ventilator Modes
- Assist-control ventilation (A/C)
- Synchronized intermittent mandatory ventilation (SIMV)
- Continuous positive airway pressure (CPAP)
Used for clients who have weak respiratory muscles and may be
unable to maintain adequate ventilation
Assist-control ventilation (A/C)
Ventilator synchronizes the mandatory breaths with the client’s own inspirations
Synchronized intermittent mandatory ventilation (SIMV)
Provides continuous positive airway pressure during spontaneous breathing
Continuous positive airway pressure (CPAP)
fever, increased WBC, purulent sputum, crackles or wheezes, pulmonary infiltrates are signs of
Ventilator-associated pneumonia
How to prevent Ventilator-associated pneumonia
1) Minimize sedation and spontaneous breathing trials
2) Early exercise and mobilization (turn q 2hrs)
3) Subglottic secretion drainage port
4) Elevate HOB 30-45 degrees
5) Oral care with chlorhexidine
6) No routine changes of ventilator circuit tubing
7) Good hand hygiene
Assessment on ETT
1- tube type: oral or nasal
2- size of airway
3- location at teeth, gums (marking on tubing)
Procedure for suctioning
- hyperoxygenate before and after
- limit suctioning time to 10 sec or less
- monitor Sp02 and ECG
- Limit suction pressure <120mmHg
- Insert until client coughs or meets resistance, whichever comes first
Complications of suctioning (LOOK AT ALL VITALS BEFORE SUCTIONING)
(a) Hypoxemia (that’s why you always hyper oxygenate first)
(b) Bronchospasm (might develop wheezing, high pressure alarm might go off) (Give albuterol for bronchospasms but if HR is high ibutropem)
(c) Increased intracranial pressure
(d) Dysrhythmias
(e) ↑ or ↓ BP
(f) Mucosal damage (excessive suctioning can cause trauma and make it bleed)
(g) Pulmonary bleeding
(h) Pain
(i) Infection
(j) ALWAYS TELL PATIENT YOU ARE GONNA SUCTION BEOFRE YOU DO.
Manage thick secretions
(1) Adequate hydration
(2) Supplemental humidification
(3) No saline instillation (DO not use saline UNLESS patient has a mucus plug)
(4) Mobilize and turn client
(5) Antibiotics as needed (if have pneumonia, yellow secretions, fever, high WBC, has smell.)
Provide oral care and maintain skin integrity q2-4 hrs
(1) Brush teeth BID
(2) Oral swabs with 1.5% hydrogen peroxide and/or
mouthwash
(3) Chlorhexidine (an antiseptic and disinfectant) oral rinse twice/day. Every 12 hours or every shift.
(4) Moisturizer- lips, tongue, gums
(5) Oropharyngeal suctioning
(6) Reposition and retape ET tube every 24 hours. Try to prevent skin breakdown
