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

3. 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)

4. 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)

5. 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

6. Interventions Heimlich maneuver Cricoidthyroidectomy
Endotracheal intubation
Tracheostomy

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

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

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

10. 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

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

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

13. 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

14. 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

15. Monitoring Cuff Pressure
Monitor cuff pressure closely
Maintain cuff pressure of mmHg or 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

16. 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

17. 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

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

19. 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