Page 59 - Critical Care Nursing Demystified

44 CRITICAL CARE NURSING DeMYSTIFIED

Advanced Airway Techniques

4 The purpose of advanced airway techniques is to permit ventilation. The
most commonly used artificial airway for providing short-term airway manage-
ment is endotracheal intubation. Endotracheal intubation is done by inserting
an endotracheal tube (ETT) into the trachea by the oral route. It is indicated
for airway maintenance, secretion control, oxygenation, and ventilation. It is
useful in cases of emergency placement inserted via the orotracheal route and
requires cuff inflation for placement stability within the trachea. One hundred
percent oxygen can be given through ETT.
A tracheostomy tube is the preferred method of long-term airway mainte-
nance in the patient requiring intubation for more than 21 days or in situations
of upper airway obstruction or failed intubation attempts. These tubes are
inserted via a tracheotomy procedure. The tracheostomy tube provides less
resistance to airflow, making breathing easier. Secretion removal is also less
difficult, patient comfort is greater, and ventilator weaning is more successful.
A tracheostomy tube also requires cuff inflation for placement stability. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

H ? How to Do It—Endotracheal

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1. Explain the procedure to the patient and family.
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2. O b tain b ase l ine vita l signs , SaO an d ca
2. Obtain baseline vital signs, SaO and cardiac rhythm.
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2. Manually ventilate the patient with a BVM as needed before intubation.
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2. Check that suction is available and functioning correctly.
3. Check the ETT cuff for leaks prior to insertion by inflating it with the correct
amount of air.
4. Position the patient on his/her back with a small rolled blanket or pillow under
the shoulder blades to hyperextend the neck and open the airway. Do not do
this if the patient has had a head/neck injury.
5. Administer sedatives, topical anesthetics, or short-acting neuromuscular
blocking medications to block the cough reflex and promote rapid and non-
traumatic intubation.