Care of the Client with an Artificial Airway NURS 108 Essex County College Majuvy L. Sulse MSN,RN, CCRN

Low Flow Oxygen Delivery System Nasal cannula 24-44% FIO2 (1-6L/min) Simple Face mask 40-60% FIO2 (5-8L/min) Partial Rebreather mask 60-75% FIO2 (6-11L/min) Non Rebreather mask 80-95% FIO2 (10-15L/min)

High Flow Oxygen Delivery System Venturi mask 24-55% FIO2 (4-10L/min) Aerosol mask, face tent, Tracheostomy collar 24-100% FIO2 (10/min) T piece 24-100% FIO2 (10L/min)

Indications for use of Artificial Airways Partial or Complete airway obstruction Aspiration from food or foreign body Laryngeal edema post intubation CNS depression from sedatives & narcotics Head trauma or neck injury Allergic reactions

Interventions Heimlich maneuver Cricoidthyroidectomy Endotracheal intubation Tracheostomy

Proper Placement of Artificial Airways Endotracheal Intubation Nasopharyngeal-inserted through the nares terminating into the oropharynx

Endotracheal Intubation Oro-pharyngeal-inserted from the mouth past the uvula into the oral pharynx

Tracheostomy -A surgical incision in the trachea (windpipe) below the larynx

Advantages of Tracheostomy Bypass an upper airway obstruction Facilitate removal of secretions Permit long term mechanical ventilation Permit oral intake & speech Less risk of airway damage Permit mobility & comfort

Types of Tracheostomy tubes Single Lumen Double Lumen Cuffed Cuffless Fenestrated Cuffed fenestrated Metal Talking

Nursing Considerations Position Side lying or semi prone position to prevent aspiration of oral secretions unless contraindicated HOB elevated 30-45 degrees Endotrach/Trach care Suction secretions as needed-(no longer than 10-15 sec) Pressure at wall suction unit between 100-120 mmHg Frequent oral care Maintain sterile technique Anchor securely

Nursing Considerations Nursing care Assess respiratory rate, rhythm, & depth Assess respiratory status every 4 hours or more Assess level of consciousness and skin color Provide notepad or picture board

Tube maintenance & anchoring Secure tube to prevent accidental extubation/tube displacement Assess position of tube frequently Use restraints, sedatives, neuromuscular blocking agents if agitated/restless Notify physician immediately if tube is dislodged

Monitoring Cuff Pressure Monitor cuff pressure closely Maintain cuff pressure of 14- 20 mmHg or 20-28 cm H20 Minimal leak technique (MLT)-withdrawing 0.1 ml of air after inflating cuff with minimal air. Is a risk for aspiration of secretions. Occlusive technique

Oxygen therapy Provide humidified oxygen Administer 100% oxygen via ETT/Trach prior to suctioning If on mechanical ventilation all alarms are enabled at all times Ambubag should always be available at the bedside Sterile suction catheters at bedside

Tracheostomy Care & Hygiene Obturator at head of bed at all times Sterile technique especially for open suction Stoma care-assess for s/s of infection Hand washing always important

Complications of Artificial Airways Infection Trauma –pneumothorax, subcutaneous emphysema Bleeding Cardiac dysrhythmias- Cardiac and respiratory arrest-tube obstruction/dislodgement Death

Nursing responsibilities for discharge or community care Teach both client & caregiver importance of tracheal care Assess level of understanding & observe return demonstration of tracheal care & suctioning Stress the importance of good hand hygiene especially when cleaning tracheostomy tube Signs & symptoms of infection especially at stoma site Provide name & number of health care personnel to be contacted for advice or in emergency situations Need for increase hydration