Airway Care

Published on 01/06/2015 by admin

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Last modified 01/06/2015

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Airway Care

Use of Artificial Airways (Modified from AARC Clinical Practice Guideline: Management of Airway Emergencies, 1995)

Indications

1. Conditions requiring management of the airway generally are impending or actual

2. Specific conditions include but are not limited to

3. Conditions requiring emergency tracheal intubation include, but are not limited to

4. Neonatal or pediatric specific

5. Conditions in which endotracheal intubation may not be possible and in which alternative techniques may be used include, but are not limited to

Contraindication

Hazards and complications

1. Failure to establish a patent airway

2. Failure to intubate the trachea

3. Failure to recognize esophageal intubation

4. Unrecognized bronchial intubation

5. Upper airway trauma, laryngeal and esophageal damage

6. Eye injury

7. Dental accidents

8. Vocal cord paralysis

9. Cervical spine trauma

10. Aspiration

11. Pneumonia

12. Endotracheal tube (ETT) problems (e.g., cuff perforation, cuff herniation, pilot tube-valve incompetence, tube kinking during biting, tube occlusion, and inadvertent extubation)

13. Inappropriate tube size

14. Bronchospasm

15. Laryngospasm

16. Dysrhythmias

17. Hypotension and bradycardia caused by vagal stimulation

18. Hypertension and tachycardia

19. Bleeding

20. Mouth ulceration

21. Tongue ulceration

22. Specific problems resulting from nasal intubation (e.g., nasal damage including epistaxis, tube kinking in the pharynx, sinusitis, and otitis media)

23. Tracheal damage (e.g., tracheoesophageal fistula, tracheal innominate fistula, tracheal stenosis, and tracheomalacia)

24. Laryngeal damage with consequent laryngeal stenosis, laryngeal ulcer, granuloma, polyps, or synechiae

25. Specific problems resulting from surgical cricothyrotomy or tracheostomy (e.g., stomal stenosis, innominate erosion)

26. Specific problems resulting from needle cricothyrotomy (e.g., bleeding at the insertion site with hematoma formation, subcutaneous and mediastinal emphysema, and esophageal perforation)

II General Classification of Artificial Airways

Oropharyngeal airway (Figure 38-1)

Nasopharyngeal airway

Laryngeal mask airway (LMA)

1. The LMA may be used to manage the airway during anesthesia or as an emergency airway when the airway is difficult to intubate.

2. The LMA is a tube with a small, inflatable mask at the distal end.

3. The LMA is inserted deep into the oropharynx with the tip of the mask just above the esophageal sphincter. After insertion the cuff of the mask is inflated. The opening in the mask should face the laryngeal opening when inserted properly (Figure 38-2).

4. Available in sizes 3, 4, and 5 for adults

5. Advantages of the LMA include

6. Disadvantages of the LMA include

Orotracheal tube

1. Advantages when compared with nasotracheal tubes

2. Problems associated with orotracheal tubes

Nasotracheal tube

1. Advantages over orotracheal tube for long-term intubation

2. Problems associated with nasotracheal tubes

a. The tip of the tube moves when the patient’s head position changes.

b. Pressure necrosis in area of the alae nasi may occur.

c. Sinus drainage may be obstructed, and acute sinusitis may result.

d. Eustachian tube drainage may be obstructed, and otitis media may result.

e. The incidence of vocal cord damage after 3 to 7 days (also seen with oral ETTs) increases.

f. Vagal stimulation is possible, but it occurs less frequently than with the oral ETT.

g. Skilled personnel are necessary for placement.

h. The nasal passage limits the tube size; a tube at least 0.5 mm ID smaller than the oral route is required.

i. The angle of curvature is acute; the resistance to gas flow is increased; there is difficulty in suctioning; and the work of breathing is increased when compared with an orotracheal tube in the same patient.

j. There is a potential for laryngeal pathology.

Tracheostomy tube

1. The size, length, and shape of a tracheostomy tube vary depending on the manufacturer and style of the tube.

2. Tracheostomy tube shapes are curved, angled, or extra long (Figure 38-3).

3. Careful consideration of the anatomy of each patient when choosing the brand and size of a tracheostomy tube may aid in preventing future complications.

4. Most tracheostomy tubes are sized according to ID in millimeters.

5. Advantages over ETTs

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