Artificial Airways Agk

8/6/2019 Artificial Airways Agk

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Nasopharyngeal

Oropharyngeal

Nasotracheal

Orotracheal

Tracheostomy


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To guarantee patency of airway

To improve airway protection To allow positive pressure ventilation

To facilitate suctioning


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Nasopharyngeal airway


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It is made of soft rubber, silicone or

polyvinyl chloride (PVC) Part ; flange at the proximal end and with a

beveled distal end

Size; distance from the nares to angle ofmandible


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I

ndication

Indicated when oropharyngeal airways are

contraindicated Advantage of the nasal airways over the oral

airways is that it is better tolerated by

conscious and semi-conscious patient.


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Contraindication

Nasal trauma

Basilar Skull fractures Deformities of the nose

Coagulation disorders


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H

azards

Sinusitis

Otitis media Gastric insufflation (if the airway is too long)

Intubation of meninges (in case of head or facialtrauma)

Occlusion of the airway by secretion Tissue necrosis

Bleeding


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Oropharyngeal airway


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Gudeal

Berman


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Holds the tongue away from pharyngeal wall

Bite block after intubation Size; lip to the angle of mandible

Inserted only in deep comatose patients


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Berman airway has an J beam construction

with a channel along each side Guedel airway is open down the middle

Size range from 000 to 6 ( premature to

adult)


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I

ndication

Unconscious patients


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Contraindication

Oropharyngeal trauma

Conscious or semiconscious patients ---------induce (vomiting and aspiration )


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H

azards

Oral trauma

Pressure necrosis (if left in place too long)

Gagging

Vomiting

Aspiration Airway obstruction ( with improper

insertion)


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Use of Endotracheal tube

To prevent airway obstruction

To facilitate suctioning To provide mechanical ventilation

To protect the lower airway from foreign

objects


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ET sizeET size

premature 2.5 10

New born 3 111- 6 months 3.5 11

6 12 months 4 12

2 years 4.5 134 5 14

6 5.5 15 16

8 6 16- 17

10 6.5 17- 18

12 7 18- 22

> 14 female 7 20 24 (21)

> 14 male 8 20 24 (23)


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Size of tracheal tube(mm) x 3

2

Rule of thumb ; outer diameter of

the suction catheter should be or < the

inner diameter of tracheal tube


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It is usually constructed of polyvinyl chloride

(PVC) or silicone

The construction of Endotracheal is standard;-------------------------

Distal end is beveled and rounded to minimize

trauma on insertion

Murphy eye ----------- ( allows passage of gas

through it if the end becomes occluded by secretion.

A cuff------- is present distal end of the tube


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Pilot tube ------- (extends past proximal end

of the tube and terminate with a pilot balloonand spring loaded valve

Radiopaque line that allows for ready

visualization of the tube on radiography

Proximal end of the tube is fitted with a

standard 15 mm adapter (universal adaptor)


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Contraindication

Generally not addressed, but two important

ones are complete obstruction of the upper airway

Lack of person trained and experienced in

tracheal intubation


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Complication

Bronchospasm

Laryngospasm

Hypoxemia

Esophageal intubation/gastric distention

Rupture of trachea/cuff

Aspiration (blood,tooth ,gastric contents) Airway obstruction

Sore throat, dysphasia


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Paralysis of vocal cords

Vocal cord adhesions Tracheal stenosis

Laryngeal edema/ulceration

Ulceration of lips, mouth, pharynx

Tracheal bleeding


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Assemble and check equipment

Position the patient Pre- oxygenate

Insert laryngoscope

Visualize and displace glottis

Insert tube

Assess tube position

Secure and stabilize airway


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Intubation


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Equipment for oral and nasal

intubation Laryngoscope handles and blades

Endotracheal tubes, assorted sizes

Tape or commercial tube fixation device Magill forceps

Syringe

Stylet

Suction

Manual resuscitator/ oxygen

Water-soluble lubricant

Sedatives and paralyzing agents


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Laryngoscope

Two principal parts; handle and blade

Two type of blade ;-------- straight and curved

Straight blade ( Miller );------ directly lift the

epiglottis to allow visualization of the vocal cords

Curved blade; (Macintosh)------- indirectly lift the

epiglottis


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Ascultation of chest and epigastrium

Observation of chest movement Tube length (cms of teeth)

Airway condensation

Capnometry/ copnography Gastric contents


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Goals ;

Relief of upper air way obstruction Long term mechanical ventilation

Acute / chronic neuromuscular conditions

Brain injury


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Tracheostomy tube

Advantages of Tracheostomy

Suctioning is facilitated It is better tolerated by the conscious patient

Fixation of tube is easier

Eating and even speaking (with proper tube )


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Tracheostomy is used when Endotracheal

intubation is impossible (complete upper

airway obstruction )

It is used when a long term airway is needed,

and it is usually considered after 10 to 14 days

of intubation


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Tracheostomy tubes made from a plastic,

such as PVC or silicone and also made ofsilver or stainless steel.

Several manufacturs also produce a

fenestrated tube (or window)


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It has four parts ;------------

Inner cannula, outer cannula, obturator and cuff

The inner cannula can be removed to cleansecretions and blood from interior surface without

removing the entire tube.

The obturator prevents blood or mucus from

entering the tube as it is being inserted and provides

a smoothly tapered surface to facilitate introduction

of the tube into the airway.


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Complication of Tracheostomy

Hemorrhage

Subcutaneous emphysema

Obstruction Wound infection

Recurrent laryngeal nerve damage

Tracheal stenosis

Dysphagia

Tracheoesophageal fistula

Subglottic edema

Aspiration and atelectasis


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Increased patient mobility

More secured airway

Increased comfort

Enchanced airway suctioning

Early transfer and mobilization

Improved oral hygiene and nutrition

Enhances communication and phonation

Reduced airway resistance


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Low volume

High pressure cuff

High volume

Low pressure cuff

bad

good


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Remove inner cannula prior to humdification

and suctioning Wash inner cannula with saline and hydrogen

peroxide

Wet gauze pads for continuoushumdification

Home care

Artificial Airways Agk

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