igel, opa, npa, suctioning Flashcards
what is an Igels terminology name
Supraglottic airway Igel
what are the indications of a supraglottic airway
Actual loss of airway patency or airway protection
What are the contradictions of a supraglottic airway
Conscious breathing patients
Continuous use for more than 4 hours
What are the complications of a supraglottic airway
Failure to provide adequate airway or ventilation
Patient intolerance
Hypoxia
Can precipitate vommiting and aspiration in a patient with intact airway reflexes
Oropharyngeal trauma
What is a supraglottic airway Igel
The igel is a second generation supraglottic airway device used extensively in resuscitation and anaesthesia. Made from a medical grade thermoplastic elastomer, Igel has been designed to create a non-inflatable, anatomical seal of the pharyngeal, laryngeal, and perilayngeal structures while avoiding compression trauma. A gastric channel facilitates venting and active suctioning by inserting an appropriately sized orogastric tube.
What are the adult sizes of a Supraglottic Airway Igel
3 - 30/60kg = small adult
4 - 50/90kg = medium adult
5 - 90kg and above = large adult
How to check if the Igel is in place
No resistance on the BVM (can squeeze the bvm)
Incisors sitting on the bite block
Fogging and misting of the tube
Rise and fall of the chest when ventilating
Breath sounds heard on auscultation
Sp02 increase
Gastric tube benefits
Passive drainage
Active intermittent suctioning
Useful in patient who are increased risk of aspiration due to gastric distension (enlarged stomach)
CPR, IPPV
drowning, excessively alcohol, food
Obese, pregnant
What does the epiglottis do
Prevents aspiration from going into the trachea
How do we know if our airway and breathing is compromised
Skin and perfusion: are they pink, cyanosed (blue) , flushed
Facial expressions: are they panicked, anxious, exhausted
Posture: tripod position, clutching at throat
Physical observations: barrel chest (COPD), accessory muscle use, intracostal and suprasternal retractions
How do you do a triple airway manoeuvre
Head tilt, jaw trust, and mouth opening
What are the indications of a triple airway manoeuvre
Patients unable to maintain airway patency
Are there any contradictions for a triple airway manoeuvre
No
What are the precautions of a triple airway manoeuvre
Potential c spinal injury
What is a OPA
An oropharyngeal airway, easily inserted airway management device extending from the lips to the pharynx, that prevents the base of the tongue from falling back and occluding the airway. A flange at the outer opening prevents the device from being inserted or pushed too far into the airway
What are the indications of an OPA
Maintain airway patency
Bite block for intubated patients
What are the contradictions of an OPA
Conscious patients
Patients with an intact gag reflex
What are the complications of an OPA
Airway trauma from OPA placement
Intolerance of OPA requiring removal
Can precipitate vomiting / aspiration in patient with intact gag reflex
Incorrect size or placement can potentially exacerbate airway obstruction
What are the colour coded OPA, their sizes and for who
Size 10 - red - large male
Size 9 - yellow - adult male
Size 8 - green - adolescent/ adult female
Size 7 - white - child
Size 6 - black - small child
Size 5 - blue - toddler
Size 4 - pink - infant
Size 3 - lilac - neonate
Additional information of an OPA
Too small an OPA device is ineffective at protecting the airway, while too large a device can press against the epiglottis and obstruct the larynx or precipitate laryngospasm
What is a NPA (nasalpharyngeal airway insertion)
It is a soft, anatomically designed airway adjunct which is inserted into the nasal passageway to provide airway patency. The flared distal end prevents the device from becoming lost within the nare.
The NPA has advantages over the OPA as it can be used in patients with intact gag reflex, trismus and oral trauma
What are the indications of a NPA
Potential or actual airway obstruction
Are there any contradictions of an NPA
No
What are the complications of an NPA
Airway trauma, particularly epistaxis
Incorrect size or placement will compromise effectiveness
Exacerbate injury in base of skull fracture, with NPA potentially displacing into the cranial vault
Can stimulate a gag reflex in sensitive patients, precipitating vomiting or aspiration
Additional information of an NPA
An NPA does not protect the patients airway from aspiration
The right nostril is often preferred for NPA insertion given that is typically larger and straighter than the left
A correctly sized NPA will have the flared end resting on the nostril
What are the 3 sizes of an NPA
Size = 24 - internal diameter (mm)= 6 / external diameter (mm)= 8.1
Size = 28- internal diameter (mm)= 7 / external diameter (mm)= 9.4
Size = 32- internal diameter (mm)=8 / external diameter (mm)= 10.8
Why is suctioning important
It decreases the risk of aspiration, promotes optimal pulmonary gas exchange and helps prevent nosocomial pneumonia
What are the 4 suction adjuncts
Y-suction catheter
Yankauer catheter
Meconium aspirator
Ducanto catheter
What is a y-suction catheter
Used for suctioning endotracheal tubes. Additionally suitable for the suctioning of the patients nares, nasopharynx, oropharynx, stoma, tracheostomy, and airway adjuncts
What is a yankauer catheter
Rigid plastic catheter with a large suction tip surrounded by a bulbous head used to remove secretions from the oropharynx and external nares
What is a meconium aspirator
Rigid plastic suction aid used in conjunction with an ETT to aid in the removal of meconium
What is the Ducanto suction catheter
It is a rigid, high volume suction that can facilitate oropharyngeal clearing in cases of heavy airway soiling during suction assisted laryngoscopy
