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Power point airway management
This document discusses various airway management techniques including coughing, suctioning, artificial airways like oropharyngeal and nasopharyngeal tubes, endotracheal tubes, tracheostomy tubes, and alternative devices like LMAs and Combitubes. It provides details on the components of an effective cough, phases of suctioning, indications for different airway techniques, proper procedures, potential hazards, and equipment required.
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Power point airway management
- 1. Artificial Airways &Airway Management 210a
- 2. Effective Cough •Components – Adequate vital capacity (VC > 15 mL/kg) – Abdominal contraction – Glottic closure
- 3. Phases of aCough • Irritation of airway • Inspiration of adequate volume • Compression – Glottic closure – Contraction of abdominal muscles – Increase in intrathoracic pressure
- 4. Phases of aCough • Expulsion – Opening of glottis – Explosive expulsion of air and matter (flow up to 500 mph)
- 5. Ineffective Cough •Inadequate vital capacity • Inadequate compression – Inadequate abdominal contraction – Inability to close glottis
- 6. Suctioning • Suctioningis the application of negative pressure to the airways through a collecting tube
- 7. Suctioning • Suctioningof the trachea and bronchi is usually done through an endotracheal tube or tracheostomy tube
- 8. Indications for Suctioning • Need to remove retained secretions • Need to maintain patency of airway • To treat atelectasis • To obtain of a sputum specimen
- 9. Hazards of Suctioning • Trauma • Hypoxia – Arrhythmias – Inadequate cerebral oxygenation
- 10. Hazards of Suctioning • Infection • Vagal stimulation • Atelectasis
- 11. Hazards of Suctioning • Bronchospasm • Increase in intracranial pressure • Gag reflex stimulation
- 12. Equipment Required For Suctioning • Oral suctioning – Negative pressure source – Suction canister – Connective tubing
- 13. Equipment Required ForOral Suctioning • Yankauer (tonsil tip) Suction tip • Distilled water or saline solution in container • Gloves
- 14. Equipment Required For Suctioning • Nasal and tracheal suctioning – Negative pressure source – Suction canister – Connective tubing – Suction catheter
- 15. Nasal & TrachealSuctioning Equipment • Water soluble gel (for nasal suction) • Distilled water or saline solution in container • Gloves
- 16. Catheter Types •Whistle tip • Argyle • Coudé • Closed catheter systems
- 17. Suction Catheters •Catheter sizes – Measured in French (French/3.14 = size in mm) – Diameter of catheter < ½ diameter of tube • Murphy eye
- 18. Pressure During Suctioning • Adult – -100 to -120 mmHg • Child – -80 to -100 mmHg • Infant – -60 to -80 mmHg
- 19. Suctioning Procedure •Gather equipment, identify patient, introduce self, explain procedure, and wash hands • Don gloves, prepare equipment
- 20. Suctioning Procedure •Hyperoxygenate the patient, as appropriate • If suctioning nasally, lubricate the catheter
- 21. Suctioning Procedure •Introduce the catheter into the airway, ensuring that no suction is applied during introduction • Advance the catheter until resistance is met
- 22. Suctioning Procedure •Withdraw the catheter 1 to 2 cm • Apply suction continuously, withdraw catheter, rotating catheter during withdrawal (NOTE: apply suction for a maximum of 15 seconds)
- 23. Suctioning Procedure •Rinse the catheter in saline or distilled water • Reassess the patient
- 24. Artificial Airways •Oropharyngeal airway – Used in unconscious patients only to avoid gag reflex – Prevents tongue from occluding airway
- 25. Oropharyngeal Airway •Allows passage of suction catheter through center or along the side of airway
- 26. Oropharyngeal Airway •Insertion procedure – Airway is upside down as it is inserted into mouth – Rotate sideways as airway passes over tongue – Place in correct position once past tongue
- 27. Artificial Airways •Nasopharyngeal airway – Used in conscious patients requiring frequent suctioning – Length of airway equals length from nostril to ear plus one inch
- 28. Nasopharyngeal Airway •Prevents tongue from occluding airway • Change from naris to naris as required
- 29. Nasopharyngeal Insertion Procedure • Lubricate airway with water soluble gel • Examine nares; if available, choose nares with smaller opening
- 30. Nasopharyngeal Insertion Procedure • Gently insert airway, avoiding forcing past obstructions • Tip of airway should be visible just past uvula
- 31. Artificial Airways •Endotracheal tubes
- 32. Endotracheal Tubes •Specifications established by the American Society for Testing and Materials (ASTM)
- 33. Endotracheal Tube Marking • I.T. – Implant tested • I.D. – Inner diameter • O.D. – Outer diameter
- 34. Endotracheal Tube Marking • Z-79 – meets standards of that committee for non-toxicity • Radiopaque line – determine position after placement • Centimeter markings to indicate depth of placement
- 35. Endotracheal Tube Type • Cuffed • Uncuffed • Double lumen • Jet ventilation
- 36. Indications for Intubation • Maintain airway patency • Prevent aspiration • Cardiopulmonary arrest
- 37. Indications for Intubation –Establishment/maintenance of mechanical ventilation –Bronchial hygiene
- 38. Physiologic Effects ofIntubation • Decrease in VD (approximately by ½) • If tube is too small, may increase resistance and work of breathing
- 39. Equipment Needed forIntubation • Suction equipment • Laryngoscope – Macintosh blade – curved – Miller blade – straight
- 40. Equipment Needed forIntubation • Stylet – only for oral intubation • Magill forceps – only for nasotracheal intubation • Oropharyngeal airway
- 41. Equipment Needed ForIntubation • Syringe • Tape or other securing equipment • Endotracheal tube – choice of sizes to meet unexpected conditions
- 42. Equipment Needed forIntubation • Topical anesthetics (lidocaine, xylocaine) – may be required • Paralyzing agents (Pavulon, succinylcholine) – for combative patients
- 43. Intubation Procedure •Assemble and check all equipment • Ensure patient is hyperoxygenated and hyperventilated, if possible • Determine desired endotracheal tube size, lubricate with topical anesthetic, if required; insert stylet for oral intubation
- 44. Intubation Procedure •Pre-oxygenate the patient • Position patient in “sniffing” position, if possible • Administer paralyzing agent, if required
- 45. Intubation Procedure •Insert laryngoscope • Visualize the vocal cords • Insert endotracheal tube between vocal cords
- 46. Intubation Procedure •Inflate the cuff • Check breath sounds; adjust position of endotracheal tube as needed • Note and record centimeter mark at the teeth
- 47. Intubation Procedure •Secure the endotracheal tube • Insert oropharyngeal airway • Obtain chest X-ray to ensure proper tube placement • Check cuff pressure
- 48. Intubation Hazards •Intubation of the esophagus • Trauma to the vocal cords or trachea • Tracheal malacia, necrosis, T-E fistula • Aspiration • Fracture of teeth
- 49.
- 50. Indications for Tracheotomy • Long term ventilation • Provide patent airway when upper airway is impassable
- 51. Hazards of Tracheotomy • Trauma – laryngeal lesions, tracheal lesions • Hemorrhage
- 52. Hazards of Tracheotomy • Subcutaneous emphysema • Infection • Tracheal malacia, necrosis, T-E fistula
- 53. Types of TracheostomyTubes • Portex / Shiley • Jackson • Kamen-Wilkensen • Fenestrated
- 54. Care of TheTracheostomy Tube • Performed as needed according to hospital protocol • Assemble and check equipment – Gloves and other protective gear – Suction equipment – Hydrogen peroxide
- 55. Care of TheTracheostomy Tube • Assemble and check equipment – Sterile water – Cotton-tipped applicators – Pre-cut gauze or 4 x 4 gauze pad – Tracheostomy tube ties
- 56. Care of TheTracheostomy Tube • Suction the patient • Remove and clean the inner cannula • Clean the stoma site
- 57. Care of TheTracheostomy Tube • Change the tracheostomy tube ties • Re-insert the inner cannula • Assess the patient
- 58. Changing of TheTracheostomy Tube • Performed as needed – Perforated cuff – Mucus plug – Change in size of tube
- 59. Changing of TheTracheostomy Tube • Assemble and check equipment – Gloves and other protective gear – New tracheostomy tube – Suction equipment – Tracheostomy tube ties – Resuscitation bag
- 60. Changing of TheTracheostomy Tube • Pre-oxygenate the patient • Suction the patient • Remove the tracheostomy tube
- 61. Changing of TheTracheostomy Tube • Insert the new tube • Secure the tracheostomy tube with the ties • Assess the patient
- 62. Management of TheCuff • Pressure should be kept between 20 and 25 mmHg
- 63. Management of TheCuff • Techniques for maintaining cuff pressure – Minimal occluding volume – Minimal leak technique – Direct measurement of cuff pressure by manometer
- 64. Alternative Airway Devices • Laryngeal mask airway (LMA)
- 65. Laryngeal Mask Airway(LMA) • Advantages – Ease and speed of insertion – Avoidance of laryngeal and tracheal trauma – Intubation possible without removing LMA
- 66. Laryngeal Mask Airway(LMA) • Disadvantages – Short term use only – Cannot provide high ventilation pressures – Potential for esophageal injury – Aspiration may still occur, although risk is decreased
- 67. Laryngeal Mask Airway(LMA) • Placement – Lubricate posterior surface of the mask – Fully deflate cuff – Using index finger, guide the insertion along the palate and into the oropharynx – Inflate cuff to maximum of 60 cmH2O
- 68.
- 69. Alternative Airway Devices • Combitube (Double lumen airway)
- 70. Combitube • Advantages – Little skill required for insertion – Protects against aspiration – Aids in positive pressure ventilation
- 71. Combitube • Disadvantages – Short term use only – Aspiration may occur during removal – If placed in esophageal position, cannot suction airway
- 72. Combitube • Disadvantages – Potential for esophageal injury – Difficulty in distinguishing between esophageal and tracheal intubation
- 73. Combitube • Placement – Insert tube blindly through the oropharynx into the trachea or esophagus – Inflate the cuffs
- 74. Combitube • Placement – Assess placement of the tube – Ventilate through the appropriate external adapter
- 75.
- 76. Alternative Airway Devices • Tracheal buttons – Used to maintain a tracheal stoma
- 77. Tracheal Buttons •Advantages – Removes the airway resistance of a tracheostomy tube – Aids in the removal of secretions by allowing continued access when cap is removed – Allows patient to communicate verbally, when able
- 78. Tracheal Buttons •Disadvantages – Will not allow attachment of mechanical ventilators – Must be removed and replaced with tracheostomy tube in emergency situations
- 79. Tracheal Buttons •Placement – Fits through the skin to just inside the anterior wall of the trachea