B- Airway Care/ETT/TRACH

  1. indications for pharyngeal airway- oropharyngeal
    • unconscious pt
    • support base of tongue
    • bite block
    • facilitate oral suctioning
  2. indications for pharyngeal airway- nasopharyngeal
    • conscious pt
    • " "
  3. complications of oropharyngeal airways
    • gagging
    • vomiting
    • laryngospasm
    • obstruction
  4. complications of nasopharyngeal airways
    • trauma to mucosa (most common) use soluble or water based lube
    • epistaxis - nasal bleeding
    • inc airway resistance
  5. indications for oral and nasal intubation
    • provide patent airway
    • access for suctioning
    • means for mech vent
    • protect airway- aspiration, obs
    • direct installation of medication
  6. direct instillation of med

    think NAVEL
    • narcan- narcotic overdose
    • atropine- bradycardia
    • valium/versed- sedative
    • epi- asystole
    • lidocaine- pvc
  7. when administering med through the ett, you should always flush with
    double the normal iv dose, and flush with 10ml of saline
  8. how should therapist respond to by passing normal filtration, humidification and warming
    provide adequate humidity
  9. complications of intubation
    • infection
    • cuff pressure
  10. cuff pressure in mm hg and cmh20
    • equal or less than 20 mm hg
    • equal or less than 25 cmh20
  11. listen for air leak as cuff is inflated during positive pressure vent; stop at min volume necessary to eliminate air leak via trach or ett
    MOV- minimal occluding volume
  12. slowly infect air into the cuff during pos pressure ins until leak stops; a small amouth of air is remoced to allow a slight leak during peak inspiration
    MLT- minimal leak technique
  13. chest x ray is the best way to determine
    tube position
  14. the tip of the tube should be
    2 cm or 1 inch ABOVE the carina or at the aortic knob/notch
  15. tube maintenance
    • suctioning
    • humidification- 100% humidity @ 37C
  16. what type of pressure cuffs to use
    high vol/pressure cuffs
  17. laryngoscope is always held in
    left hand
  18. fits into vallecula, indirectly raises the epiglottis
    curved/macintosh blade
  19. fits directly under the epiglottis- preferred for infant intubation
    straight/miller blade
  20. blade size for adult
  21. blade size for ped
  22. blade size for term infant
  23. blade size for pre term
  24. stylet is used only to aid in
    oral intubation
  25. the end of the stylet has to be recessed ___ above tip of ett
  26. magil forceps used only to ain in
    nasal intubation- inserted through the mouth
  27. ett size preterm
  28. ett size full term
  29. ett size adult males
    8.0-9.0 mm
  30. ett size adult females
  31. tube markings on oral intubation should be
    21-25 cm mark on pt lips
  32. if the tube is on 29 cm at the lip then its on the
    right main stem
  33. tube markings on nasal intubation should be
    26-29 cm mark at pt nare
  34. Double lumen ett (DLT)/ Endobronchial tube / Carlens tube
    • each lumen can ventilate one lung seperately
    • independent lung ventilation
    • used during surgery
  35. LMA consists of an inflatable mask that is positioned directly over the
    opening into the the trachea
  36. a standard ett can be inserted directly through
    the LMA
  37. insertion of the LMA does not require the use of
  38. LMA is indicated for
    • short term vent
    • when intubation is not possible by oral or nasal route (facial or nasal injuries)
  39. this tube is indicated for the use of oral or nasal ett that requires CONTINUOUS ASPIRATION of subglottic secretions
    hi-lo evac tubes
  40. hi-lo evac tube has a separate suction port into the ett just above the
  41. hi-lo's cont suctions is provided via separate pilot conneected to a vacuum pressure of
    20 mm hg
  42. CASS has been shown to reduce the incidence of
  43. before you extubate the pt you must FIRST
    suction airways below and then above cuff and mouth
  44. you must deflate the cuff and have the pt inspire deeply and must remove the tube at
    PEAK inspiration- to prevent vocal damage
  45. after removing the tube, you must have the pt
    • cough to clear any secretions
    • administer o2
  46. after extubation, observe for any complications
    • laryngeal edema-stridor
    • resp obstruction
  47. if the pt has SEVERE resp distress and a marked stridor then you must
  48. if the pt has MODERATE or MILD stridor or sore throat then you must give
    • o2
    • cool mist
    • recemic epi
  49. ett is replaced with a trach after how many weeks
    1 week- long term ventilation
  50. the cuff should be kept inflated whenever pt is
    • eating
    • on pos pressure vent
  51. trach should be changed if
    • obstructed
    • too small
    • punctured cuff
  52. when the trach is obstructed, you are unable to pass a suction cath, you should then
    • remove tube
    • ventilate
    • insert new tube
  53. if the tube is too small a very high
    cuff pressures >20 mm hg needed to seal cuff
  54. which trach tube has opening in outer cannula above the cuff
    fenestrated tube
  55. fenestrated tubes are used for
    • weaning
    • temp mech vent w/ inner cannula
  56. when plugging the fenestrated tube, be sure to
    • deflate cuff
    • remove inner can
  57. fenestrated tubes allows pt to breath through
    upper airways and speak
  58. which tube is used to maintain stoma (tracheostomy opening)
    tracheal button
  59. which tubes has a feature adjustable flanges that allow adjustments of horizontal distance

    it is also an indication for pt who are obese or use cervical collars
    extended tracheostomy tubes
  60. trach tube that is metal/ and is not for resuscitation or positive press vent/ for pt with trachea stenosis/ trach is cuffless
  61. trach that is foam filled cuff/ do not inflate the cuff with a syringe
    kamen-wilkinson foam/ bivona cuff
  62. when using a tracheal speaking device, don't forget to
    deflate the cuff
  63. clean all inner cannula by soaking it in a solution of
    • hydrogen peroxide and water
    • rinse with sterile water
  64. indication of a laryngectomy
    surgical removal of the pts larynx (top portion of the trachea)
  65. laryngectomy tubes will be removed after
    3-6 weeks, pt will then have a permanent stoma
  66. laryngectomy tubes are made of
    soft pliable material
  67. laryngectomy tubes do NOT have a
    inflatable cuff
Card Set
B- Airway Care/ETT/TRACH
B- Airway Care/ETT/TRACH