AIRWAY MANAGEMENT

By the end of the lecture, students should be able to:

Identify guidelines used in managing the airway Describe methods for airway management Discuss the indications for airway suctioning Discuss the indications for tracheostomy care Describe the steps of the following procedures prior to learning them practically:
Oropharyngeal suctioning Airway suctioning Endotracheal care Tracheostomy care

Involves maintaining patency of the nose and upper airway, as well as trachea and lower airway respiratory system Non-invasive and invasive

Non-invasive:
Hydration Positioning Nutrition Chest therapy airway clearing techniques Mucous clearance device therapy Deep breathing Coughing Humidity Aerosol therapy Medications e.g. antibiotics, bronchodilators (adjunct)

Invasive
Suctioning Artificial airway Endotracheal tube Tracheostomy tube

Know your patients normal range of vital signs and oxygen saturations
Baseline means to identify abnormalities and to recognize onset of a worsening condition

Know your patients medical history

Smoking alters normal mucociliary clearance Certain disorders place the patient at an increased risk of airway obstruction

Identify conditions that may increase the risk for aspiration of gastric contents into the lung, resulting in airway obstruction
Presence of enteral feeding tubes Decreased level of consciousness Decreased swallowing ability

Determine if patient has a history of nasal problems:

Nasal trauma, nasal polyps, chronic sinus Allergy problems causing mucosal swelling

Assess patient and determine type and frequency of intervention based on assessment findings:
Know of any acute and gradual changes in your patient Respiratory rate, pattern, muscles used, breath sounds, effective cough, integrity of rib cage, characteristics of sputum production etc. Nursing care can change from shift to shift

Become familiar with equipment to be used:

Identify equipment Test before use safety Have adequate supplies at the bedside

Commonly use a Yankeur (or tonsillar) suction catheter Useful in removal of secretions from the mouth Patients with artificial airway: used to promote oral hygiene

Remove secretions from pharynx and the trachea Used when a Yankeur is ineffective or inappropriate; or when lower airway requires removal of secretions A suction catheter is used (there are different sizes to choose from)

Age Group
Preterm infants

Pressure Setting (mmHg)

40 60

Infants
Children Adults

60 100
60 100 80 120 *More tenacious sputum may require more suction (up to 200 mmHg)

Endotracheal (ET) tubes and tracheostomy tubes artificial airways inserted to

Relieve airway obstruction Provide a route for mechanical ventilation Permit easy access for secretion removal Protect airway from gross aspiration in clients with impaired cough or gag reflexes

ET intubation procedure performed by a physician or specially trained personnel Inserted through the nares or the mouth, past the epiglottis and vocal chords into the trachea

Inserted directly into the trachea through a small incision made in the patients neck Temporary or permanent