SVCC Respiratory Care Programs ARTIFICIAL AIRWAYS

SVCC Respiratory Care ProgramsSVCC Respiratory Care Programs

ARTIFICIAL AIRWAYSARTIFICIAL AIRWAYS


DefinitionDefinition

A tube or tube-like device that is A tube or tube-like device that is inserted through the nose, mouth, or inserted through the nose, mouth, or into the trachea to provide an opening into the trachea to provide an opening for ventilationfor ventilation


Types of Artificial AirwaysTypes of Artificial Airways

Oropharyngeal airwaysOropharyngeal airways Nasopharyngeal tubesNasopharyngeal tubes Orotracheal tubesOrotracheal tubes Nasotracheal tubesNasotracheal tubes Tracheostomy tubesTracheostomy tubes Esophageal obturator airwayEsophageal obturator airway Cricothyroid tubesCricothyroid tubes


Indications for Artificial AirwaysIndications for Artificial Airways

Relief of airway obstructionRelief of airway obstruction --guarantees the patency of upper guarantees the patency of upper airway airway regardless of soft tissue obstruction.regardless of soft tissue obstruction.

Protecting or maintaining an airwayProtecting or maintaining an airway N. have 4 main airway protect. N. have 4 main airway protect. reflexesreflexes1. 1. Pharyngeal reflex Pharyngeal reflex - - 9th & 10th cranial nerves9th & 10th cranial nerves gag and swallowinggag and swallowing


Indications (cont’d)Indications (cont’d)

Reflexes (cont’d)Reflexes (cont’d)2.2.LaryngealLaryngeal-vagovagal reflex-vagovagal reflex -- will will cause laryngospasmcause laryngospasm 3.3.TrachealTracheal

-vagovagal reflex-vagovagal reflex-- cough when a foreign body cough when a foreign body

or or irritation in tracheairritation in trachea4.4.CarinalCarinal-cough with irritation of carina-cough with irritation of carina


Indications (cont’d)Indications (cont’d)

Facilitation of tracheobronchial clearanceFacilitation of tracheobronchial clearance

- - mobilization of secretions from the trachea mobilization of secretions from the trachea requires either an adequate cough or direct requires either an adequate cough or direct suctioning of the tracheasuctioning of the trachea

Facilitation of artificial ventilationFacilitation of artificial ventilation

- ventilation with a mask should on - ventilation with a mask should on be be used for short periods d/t gastric used for short periods d/t gastric insufflationinsufflation


Hazards of Artificial AirwaysHazards of Artificial Airways

Infection d/t bypassing the normal Infection d/t bypassing the normal defense mechanisms that prevent defense mechanisms that prevent bacterial contaminationbacterial contamination

Ineffective cough maneuverIneffective cough maneuver Impaired verbal communicationImpaired verbal communication Loss of personal dignityLoss of personal dignity


Oropharyngeal AirwayOropharyngeal Airway

Device designed for insertion along the Device designed for insertion along the tongue until the teeth &/or gingiva limit the tongue until the teeth &/or gingiva limit the insertioninsertion

Lies between the posterior pharynx and the Lies between the posterior pharynx and the tongue and pushes the tongue forwardtongue and pushes the tongue forward

Will activate the gag reflex, should use on Will activate the gag reflex, should use on unconscious patientunconscious patient

Correct sizing of airway is imperativeCorrect sizing of airway is imperative


Hazards of Oropharyngeal Hazards of Oropharyngeal AirwayAirway

If too small, may not displace tongue or If too small, may not displace tongue or may cause tongue to obstruct airway or may cause tongue to obstruct airway or may aspiratedmay aspirated

It too large, may cause epiglottis It too large, may cause epiglottis impactionimpaction

Roof of mouth may be lacerated upon Roof of mouth may be lacerated upon insertioninsertion

Aspiration from intact gag reflexAspiration from intact gag reflex


Nasopharyngeal AirwayNasopharyngeal Airway

Located so that it can provide a clear path for Located so that it can provide a clear path for gas flow into the pharynxgas flow into the pharynx

Is a soft rubber catheterIs a soft rubber catheter Can be tolerated by the conscious patientCan be tolerated by the conscious patient Useful for patient with a soft tissue Useful for patient with a soft tissue

obstruction who have jaw injury or spasm of obstruction who have jaw injury or spasm of jaw musclesjaw muscles

Proper sizing and insertionProper sizing and insertion


Orotracheal AirwayOrotracheal Airway

Used in conditions of, or leading to Used in conditions of, or leading to respiratory failurerespiratory failure

Usually the method of choice in Usually the method of choice in emergencies that do not involve trauma emergencies that do not involve trauma to the mouth or mandibleto the mouth or mandible

Oral route in usually easiest Oral route in usually easiest Accomplished by using a laryngoscope Accomplished by using a laryngoscope

to directly visualize the tracheato directly visualize the trachea


Nasotracheal AirwayNasotracheal Airway

More difficult route than oralMore difficult route than oral Requires a longer and more flexible Requires a longer and more flexible

tracheal tubetracheal tube Insert through nose by touch and when Insert through nose by touch and when

in oropharynx use larynoscope and in oropharynx use larynoscope and forceps (can perform “blind”)forceps (can perform “blind”)

Usually N. T. tube is better tolerated by Usually N. T. tube is better tolerated by patient than oralpatient than oral


Tracheostomy TubeTracheostomy Tube

Tracheostomy is performed through the Tracheostomy is performed through the anterior tracheal wall either by the open anterior tracheal wall either by the open method or percutaneous methodmethod or percutaneous method

Performed usually to prevent or treat Performed usually to prevent or treat long-term respiratory failurelong-term respiratory failure

Decreases anatomic deadspace by Decreases anatomic deadspace by 50%50%


Complications and Hazards of Complications and Hazards of TracheostomiesTracheostomies

Postsurgical bleedingPostsurgical bleeding InfectionInfection Mediastinal emphysemaMediastinal emphysema PneumothoraxPneumothorax Subcutaneous emphysemaSubcutaneous emphysema Stoma collapse (should not be moved Stoma collapse (should not be moved

or changed first 36 hours)or changed first 36 hours)


Esophageal Obturator AirwayEsophageal Obturator Airway(EOA)(EOA)

Place in the esophagus to prevent stomach Place in the esophagus to prevent stomach contents from entering the lungs while the contents from entering the lungs while the patient is being artificially ventilatedpatient is being artificially ventilated

Cuff must be passed beyond carina before Cuff must be passed beyond carina before inflatedinflated

Inflated cuff with 35 cc airInflated cuff with 35 cc air Mask must fit tightly to ensure ventilationMask must fit tightly to ensure ventilation


Pharyngealtracheal Lumen Pharyngealtracheal Lumen Airway (PTL)Airway (PTL)

Double-lumen airway combining an Double-lumen airway combining an EOA and an endotracheal tubeEOA and an endotracheal tube

Designed to be inserted blindlyDesigned to be inserted blindly Has an oropharyngeal cuff and a cuff Has an oropharyngeal cuff and a cuff

that can seal off either the trachea or that can seal off either the trachea or the esophagusthe esophagus


Other Specialized ET TubesOther Specialized ET Tubes

Rae TubeRae Tube, directs the airway connection , directs the airway connection away from the surgical fieldaway from the surgical field

Endotrol TubeEndotrol Tube, controls the distal tip for , controls the distal tip for intubationintubation

Hi-Lo Jet Tube, Hi-Lo Jet Tube, for high freq. jet ventilation for high freq. jet ventilation Laser Flex Tube, Laser Flex Tube, reflects a diffused beam if reflects a diffused beam if

comes in contact with tubecomes in contact with tube Endobronchial TubesEndobronchial Tubes

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SVCC Respiratory Care Programs ARTIFICIAL AIRWAYS