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Care of the Client with an Artificial Airway

Learn about low and high-flow oxygen delivery systems, indications for artificial airways, different insertion techniques, tracheostomy care, and nursing responsibilities for clients with artificial airways. Understand tube maintenance, anchoring, cuff pressure monitoring, oxygen therapy, and potential complications.

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Care of the Client with an Artificial Airway

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

  2. 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)

  3. 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)

  4. 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

  5. Interventions • Heimlich maneuver • Cricoidthyroidectomy • Endotracheal intubation • Tracheostomy

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

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

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

  9. 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

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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

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

  18. 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

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