Airway management rcp 250 Flashcards
What 3 areas do respiratory therapists need to be proficient in?
Airway clearance techniques, insert and maintain artificial airways, and assist physicians in performing special procedures
Suctioning
application of negative pressure to the airways through a collecting tube
suctioning can be performed via
the upper airway (oropharynx), the lower airway (trachea and bronchi), bronchoscopy
Oropharynx suction device
Rigid tonsillar / Yankauer
Nasotracheal suction device
flexible suction catheter
endotracheal suction device
in-line, closed system suction catheter / ballard
techniques for endotracheal suctioning
Open / Closed
Open technique
sterile technique that requires disconnecting patient from ventilator - used more commonly with tracheostomy patient not receiving mechanical ventilation
closed technique
uses sterile, closed-system, in-line suction catheter that is attached to ventilator circuit - can be advanced into patients endotracheal airway without ventilator disconnection
Indications for endotracheal suctioning
abnormal breath sounds (course crackles- rhonchi)
What are normal suction pressures
neonates (80-100 mmHg), Children (100-120 mmHg), Adults (120-150 mmHg)
What can happen if suction pressure is too high?
atelectasis due to too much negative pressure
suction catheter sizes
usually 22 inches long - diameter of catheter should be less than 50% of the internet diameter of the artificial airway in adults / less than 70% in infants / small children
figuring the proper catheter size
multiply the tube diameter by 2, then use the next smallest catheter size
what can happen if the catheter is too large?
can cause airway obstruction, atelectasis, or hypoxemia
hyperoxygenation
before suctioning deliver oxygen for 30-60 seconds
you do not apply suctioning when
inserting the catheter
When do you apply suction and for how long
suction while withdrawing the catheter and for 15 seconds
Reoxygenation
deliver 100% of oxygen for 30-60 seconds after suctioning
Steps for Endotracheal Suctioning
- Assess patient for indications
- Assemble and check equipment
- Assess patient for hyperoxygenation
- Insert catheter
- Apply suction and clear catheter
- Reoxygenate patient
- Monitor patient and assess outcomes
Adverse responses
Hypoxemia Cardiac Dysrythmias Hypotension Hypertension Atelectasis Mucosal Trauma ICP Bacterial colonization of lower airway
Nasotracheal suction
patients with retained secretions without an artificial airway
Nasotracheal suction procedure
use sterile water lubricating jelly, place patients in the sniffing postion,
atelectasis
correct suction pressures, and suction for the max of 15 seconds, use the correct catheter size, avoid disconnection from ventilator, use High FiO2/ PEEP
sputum samples
to identify organisms infecting the airway to determine sensitivity and identify the appropriate antibiotics. Sterile technique.
OPA - oropharyngeal airway
prevent airway obstruction by keeping tongue pulled toward and away from the posterior pharynx
measure OPA
corner of the mouth to the angle of the jaw
how to insert OPA
invert the OPA to insert then twist it into place (can cause gagging/ vomiting)
contraindication of OPA
trauma to the oral cavity or madibular/ maxillary areas of the skull, facial deformities
NPA - nasopharyngeal airway
restores patency by separating the tongue from the posterior pharyngeal wall - most often used for frequent nasotracheal suctioning
measure NPA
place NPA on the side of patients face with the flange even with patients nose - measure from nares to earlobe
how to insert NPA
bevel faces septum and down one nostril with lubricant
contraindications for NPA
trauma to nasal region or foreign object present
components of ETT
- length markings (indicates distance in CM from distal end)
- Murphy Eye (side port for gas flow in case bottom becomes obstructed)
- CUFF (inflation of cuff seals lower airway, prevents aspiration, provides positive pressure)
- Pilot Balloon (used to monitor cuff status / pressure)
- valve on Pilot Balloon (connection for syringe that allows inflation / deflation cuff)
- Radiopaque Indicator (distal end, identifies tube position on chest xray)
Specialized endotracheal tubes
used for special ventilation methods, lung pathological conditions, and surgical procedures
double-lumen ETT
used for independent lung ventilation when unilateral lung disease occurs. double components
combi-tube
designed to be inserted blindly through the oropharynx and into the trachea or the esophagus (if placed in trachea functions like ETT, if in esophagus ventilation occurs through a seriers of holes into the trachea
LMA - laryngeal mask airway
inserted deep inside oropharynx, cuff is inflated once inserted, usually used by paramedics
average size of ETT for women
7.0-7.5
average size of ETT for men
8.0-8.5
equipment needed for ETT
suctioning equipment, and appropriate pressures laryngoscope - handle and lighting appropriate size of ETT Inflate and deflate cuff and check for any leaks Lubricant Stylet to insert in tube Towels colorimetric carbon dioxide detector stethoscope Syringe Oxygen/ Tubing
How to insert laryngoscope
hold in left hand
insert into right side of mouth and move toward the center (displacing the tongue)
Tip of blade is advanced until epiglottis is visualized
laryngoscope blades
- macintosh- curved - epiglottis is displaced indirectly by advancing tip of the blade into the vallecula
- Miller - straight - epiglottis is displaced directly by advancing tip of the blade over its posterior surface
Inserting ETT
- tube is inserted from the right side of the mouth
- advanced without obscuring the glottic opening
- when cuff is advanced past vocal cords - placement
- stabalize tube with right hand / withdraw laryngoscope and stylet with left hand/ cuff is inflated and ventilation starts immediately
what pressure is the ETT cuff inflated to
20-30 cmH2O
Where is the ETT positioned above the carina
3-5CM
How to assess placement of the ETT at bedside
breath sounds - no gastric sounds chest movement colorometer laryngoscope brocnhoscope xray tube length
Tube Length
women (19-21cm)
men (21-23cm)
Steps of ETT
- assemble and check equipment
- position patient
- preoxygenate and ventilate patient
- insert laryngoscope
- visualize glottis
- displace epiglottis WATCH TEETH
- insert ETT
- assess ETT position
- Stabilize ETT
Nasotracheal intubation
when oral route is unavailable due to maxillofacial injuries or undergoing oral surgery
Two techniques for nasotracheal intubation
BLIND or DIRECT visualization,
Blind - listen to airflow and breath sounds become louder
Direct- video laryngoscope
