Page 178 - Clinical Application of Mechanical Ventilation

144 Chapter 5

Some recommendations for the safe placement of a DLT (Fitzmaurice, 1999) in-
clude (1) choose the largest PVC DLT that is appropriate for the patient, (2) remove
the bronchial stylet once the tip of the tube is past the vocal cords, (3) never overinflate
either cuff and use 3-mL syringe to inflate the bronchial cuff, (4) when nitrous oxide
is used, measure the cuff pressures intermittently and keep the bronchial pressure
,30 cm H O, and (5) deflate the bronchial cuff when lung isolation is not required.
2
Summary

Special airways discussed in this chapter are useful in situations where bag/mask venti-
lation is inadequate, endotracheal intubation is not readily achievable, or independent
lung ventilation is required. A respiratory care practitioner should be knowledgeable
and proficient in the use of these airways in different patient and clinical situations.

Self-Assessment Questions

1. During bag/mask ventilation of a 70-kg patient, the therapist encounters a great deal of airflow resistance
during inspiration. The therapist should select an oropharyngeal airway with a length that is equal to the
distance from the:

A. center of the mouth to the angle of the jaw.
B. corner of the mouth to the angle of the jaw.
C. tip of the nose to the earlobe.
D. ridge of the nose to the earlobe.

2. A nasopharyngeal airway may be used as an airway adjunct in all of the following conditions except
patients with:
A. intact gag reflex. C. trimus (lockjaw).
B. oral trauma. D. epistaxis (nose bleed).

3. The normal size range of nasopharyngeal airway for adults ranges from:

A. 6 to 8. C. 4 to 6.
B. 2 to 4. D. 8 to 10.

4. An inward migration of a nasopharyngeal airway may be prevented by:
A. using the larger size nasopharyngeal airway.
B. using a safety pin on the distal end of the nasopharyngeal airway.
C. leaving at least 2 inches of the nasopharyngeal airway outside the nare.
D. using a nasal cannula to hold the nasopharyngeal airway in place.

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