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52 terms

Artificial Airways

Exam 4
STUDY
PLAY
Indications
pt loses ability to breathe spontaneously
-upper airway obstruction (foreign body obstruction)
-lower airway obstruction (bronchospasm)
-altered drive to breathe (drug overdose)
Benefits
restore gas exchange within minutes
Increase Raw
artificial airways
-increase Raw
-the smaller the tube, the higher the Raw & WOB
-more curves in the tube will increase Raw
common cause of upper airway obstruction
tongue occludes the airway
-elevating & extending head may alleviate obstruction by placing mouth, pharynx, & larynx in alignment
Head tilt
tilt head back to relieve soft tissue obstruction (tongue is moved farther from hard & soft palates to get patent airway)
-one hand under neck & one on forehead, lift neck & tilt head back
-contraindicated w/head/neck injury
Jaw thrust
both hands on jaw at ramus on each side & lift jaw forward (tongue is moved farther from hard & soft palates to get patent airway
-tx of choice for suspected neck injury
swallow
1st reflex in upper airway; receptors in oropharynx cause involuntary reflex that move object to esophagus
-lack of this reflex may allow oral secretions to pool
gag reflex
oropharynx vagal receptors will cause gagging w/stimulation;may induce vomiting; strong reflex
-may be depressed w/anesthesia, drugs, lidocaine
laryngeal reflex
stimulation of larynx will cause epiglottis to slam shut & vocal cords to come together - laryngospasm (food goes down the wrong pipe)
tracheal reflex
stimulation of trachea will cause cough (sensitive to foreign body)
carinal reflex
extremely sensitive; cough reflex
loss of consciousness & causes of upper airway obstruction
as lose consciousness, reflexes are lost in descending order from swallow to carinal
-LOC is reflected in presence or absence of reflexes
-regained in ascending order from carinal to swallow
oral pharyngeal device
most common to get patent airway obstruction
Guedel airway
must extend past posterior portion of tongue to allow airflow
-can be used as bite block in orally intubated pts
Guedel airway components
hollow channel for air passage
buccal flange
bite portion
curved portion to fit anatomy
Berman airway
similar to Guedel, but doesn't have central channel
Sizing oral pharyngeal airways
length in mm
correct size from angle of jaw to lips or earlobe to lips
Insertion technique
insert upside down with tip riding along hard palate until past tongue then rotate 180 degrees
-flange pops out of mouth if airway tip is not past posterior tongue
contraindications to oropharyngeal airways
-pts who are conscious or have airway reflexes (can cause gag,vomit, dental damage by biting)
nasopharyngeal airways (nasal trumpet/nasal airway)
better tolerated in semi-awake pt who have some reflexes
-proximal end is flared so doesn't slip down
nasopharyngeal airway sizing
size by holding airway along side of head
-tip should extend past angle of jaw
-tip lies just past base of tongue separating tongue from posterior pharynx
nasal trumpet insertion
insert parallel to floor of pharynx & slightly medially
-follow anatomy posteriorly
-if resistance, may twist
nasal airway advantages
to protect nose from trauma of nasotracheal suction
-better tolerated than oral airways
-improved oral hygiene
-improved communication
-greater comfort
hazards & contraindications to nasal airways
-pts w/bleeding concerns
-deviated septum
-basal skull fracture
-sinus infection if left in long term
laryngeal mask airway (LMA)
small, triangular shaped inflatable mask secured to tube. when inflated, tip rests against upper esophagus lying under base of tongue
-seals the esophageal sphincter & patent airway for PPV
-disposable & reusable types
-placed blindly, 15mm connector
LMA advantages
reduces amt of aspiration compared to unprotected airway
-insertion simple
LMA insertion
cuff check, deflate & evert, lubricate
-insert (may extend head, may use finger to guide)
-tube is advanced until fully seated & resistance is felt
-inflate
-should move about 1cm out as inflated
-check breath sounds
Combitube
double lumen device gives patent airway; insert blindly;may use w/difficult intubations or in field
-2 cuffs to seal esophagus & pharynxx
-lubricate & orally insert; advance until resistance
-inflate esophageal cuff w/15 ml & pharyngeal cuff w/ 100 ml
-if esophageal lumen goes into trachea, ok to ventilate like an ETT
-if lumen goes into esophagus, ok due to series of holes near hypopharynx that will allow for ventilation of lungs
Endotracheal Tubes (ETT)
best choice for secure airway
-secretion removal, PPV, meds, aspiration prevention, bronchoscopy
-requires skill & equipment (laryngoscope)
-ventilate & oxygenate before, b/w, & after
Components of ET tube
plastic tube w/beveled tip to reduce trauma, sidehole (murphy eye), cuff attached to pilot balloon w/spring-loaded valve, 15 mm standard connector
-distance markers in cm & radiopaque marker along length
-murphy eye allows gas flow if bevel tip is obstructed
Collapse ETT tube
created spiral wire-embedded tubes
Bend ETT tube
RAE tube
Fires in surgery
metal tubes & water filled cuffs
Double lumen ETT
unilateral lung disease; independent ventilation, 2-15mm connectors, 2 lumens, 2 cuffs, 2 distal openings, 1 cuff seals trachea, other seals opposite bronchus
-can deliver diffrent ventilation to each lung
Indications for Double-lumen ET's (DLET)
lung resection
lung protection from unilateral contamination
lung transplant
Tracheostomy tubes (TT)
outer cannula provides structure
flange prevents tube slippage into trachea
removable inner cannula
obturator for tube insertion
radiopaque indicator
tracheotomy
surgical procedure that established access to trachea via neck incision
-preferred route for long term pt who needs artificial airway or after prolonged period of oral or nasal intubation
Percutaneous Tracheotomy Procedure
dissection to trachea, insert needle & sheath into trachea b/w cricoid & 1st ring or b/w 1st & 2nd ring
guide wire through sheath
sheath removed & dilator passed over guidewire
larger & larger dilators used until stoma large enough for TT
rapid procedure w/ less complications than traditional surgery
Indication for trach
patent airway following intubation or when can't intubate
-protect lower airway
-suction
-long term vent
cuffed disposable TT
PVC; no inner cannula; changed every 7 days
cuffed TT w/ disposable or removable inner cannula
remove inner cannula to clean or if obstructed
cuffed fenestrated
window in outer cannula
-remove inner cannula
-plug it & deflate cuff
-pt can breathe through upper airway
-assess upper airway function
-helps wean
-allows speech
Jackson tube
nondisposable reusable silver trach w/ removable inner cannula
Bivona foam cuff
foan cuff that self inflates
-once in place, pilot tube opened to atm
-foam expands by itself, sealing airway
tracheostomy button
aids in weaning from trach
-spacer rings to adjust length of button
-adapter available for ventilation
Kistner button
has one way valve can be inserted over tube
inhale thru tube
during exhalation, valve closes forcing air up thru upper airway
makes speech possible
Olympic trach talk
appliance used w/ trach
aerosol T w/ one way valve
trach cuff deflated
inhale thru tube
when exhale valve closes & forces air to upper airway
makes speech possible
Passy-Muir valve
one way valve device placed on the trach tube
during insp. allows pt to inhale thru TT
during exhalation, valve closes & forces air thru upper airway so pt can speak
recommended cuff pressure
20-25 mmHg
Pilot balloon purpose
monitors cuff status & pressure
Purpose of the obturator
assists in trach insertion
Purpose of trach button
maintain patency of stoma & for weaning off trach