Name: PATRICIA FEB G.

DE LOS SANTOS Date: December 2020

Evaluator/Signature: Jude D. Positos, RN, MAN Grade: _____________

ASSISTING IN THE INSERTION OF AN ORAL AIRWAY AND ENDOTRACHEAL TUBE

Description:
● An oropharyngeal airway (a.k.a an oral airway, OPA, or guedel pattern airway) is a medical device called an airway adjunct used to maintain or open a patient’s airway. It does this by
preventing the tongue from covering the epiglottis, which could prevent the person from breathing. When a person becomes unconscious, the muscles in their jaw relax and allow the
tongue to obstruct the airway.
● Endotracheal intubation is a medical procedure in which a tube is placed into the windpipe (trachea) through the mouth or nose. In most emergency situations, it is placed through the
mouth.
Purpose:
Oral airway: Endotracheal Tube:
1. Hold tongue forward to maintain an open airway. 1. Treatment of symptomatic hypercapnia.
2. Facilitates removal of secretions. 2. Treatment of symptomatic hypoxemia.
3. Airway protection against aspiration.
4. Pulmonary toilet, facilitates functioning..
5. Delivery of anaesthetic and other drugs via ETT.
6. More effective ventilation and oxygenation.
Contraindications:
1. Awake patient.
2. Airway can be managed less invasively.

Equipment (Oral airway):

● Oral airway ● Tongue depressor
● Equipment for suctioning ● Petroleum jelly
● Tape strips (one approximately 20 inches, one 16 inches (may use commercially ● Mouth moistener or swabs with mouthwash
manufactured airway holder) ● Non-sterile glove

Equipment (Endotracheal Tube):

● IV access, EKG, pulse oxy monitors ● Bag valve mask
● Suction apparatus ● Appropriate size endotracheal tube (7.5 mm - adult, child = diameter or little finger) ;
● Non-rebreather mask with stylet and 10cc syringe
● Oxygen ● Laryngoscope blade and handle
● Tape
Assessment Parameters
 LOC, agitation and ability to push airway from mouth
 Respiratory status (RR, congestion in upper airways), BP, and pulse.
 Presence of cyanosis
 Color, amount and consistency of secretions
 Condition of oral mucous membranes
 Alternative methods of maintaining airways
 Use of dentures/ dentition codes

Nursing Diagnoses: Ineffective breathing pattern related to airway blockage by tongue

Desired Outcomes:
● Client will maintain clear airway passage, evidenced by normal breathing rate and clear breath sounds
● Airway is patent and free of secretions.

Special Considerations in Planning and Implementation

General
● If the client is alert and agitated enough to push airway out do not insert. Airway could stimulate gag reflex and cause client to aspirate. Use
another method of maintaining the airway if needed. If goal is to prevent client from being an endotracheal tube, use a bite block, preferably a
dental bite block, and secure it well to prevent block from sliding to back of throat.
Pediatric
 Check for appropriate airway size before insertion because pediatric-sized oral airways are available. Use the Broselow pediatric list or place the
airway to approximate size.
Geriatric
● Remove dentures if present before insertion.
End-of-Life Care
● If desired, use oral airways to maintain an open airway and provide access for suctioning in client’s who are not alert. Do not use them in clients
who are alert as they are uncomfortable and unnatural.
Home Health
● Teach family how to insert airway and perform maintenance between nurses visits
Transcultural
● Clients from some ethnic/cultural backgrounds consider touching the head a taboo. Discuss alternatives, such as having a family member assist
with insertion. Clients who are African, use caution when assessing for cyanosis, particularly around the mouth, because this may be dark blue
normally. Coloration varies from person to person and should be carefully evaluated on an individual basis
Delegation
● Insertion of oral airways should not be delegated to unlicensed assistive personnel. Respiratory therapy personnel often perform the procedure.
 PERFORMED
ACTION RATIONALE REMARKS
YES NO
FOR ORAL AIRWAY
1. Explain the procedure to client and family. To alleviate fear and for cooperation to the procedure

2. Perform hand hygiene and organize equipment. Deters the spread of microorganism. With equipment readily available saves
time and facilitates accomplishment of task

3. Lay long strip of tape down with sticky side up and place Prepares tape to hold airway
short strip of tape over it with sticky side down, leaving
equal length of sticky tape exposed on either end of long
strip. Split either end of tape 2 inches. A commercial
holder may also be used.
4. Don gloves. Gloves protects against pathogens. Avoid contact with secretions

5. Rinse airway in cool water. Facilitates insertion

6. Open mouth and place tongue blade on front half of Flattens tongue, making insertion easier
tongue.
7. Turn airway on side and insert tip on top of tongue. Promotes deeper insertion of airway without stimulating gag reflux

8. Slide airway in until tip is at lower half of tongue. Follows of glottic of oral passage

9. Remove tongue blade. To facilitate insertion of airway

10. Turn airway so tip points toward tongue; outer ends of Ensures accurate placement
airway should be vertical.
PERFORMED
ACTION RATIONALE REMARKS
YES NO
11. Place tape under client's neck with ends lying on either Places tongue under curve of airway, holding tongue forward and away from
side. pharynx

12. Pull one end of tape across client's mouth with splits taped Secures airway in mouth
across upper and lower ends of airway.
13. Repeat with other end of tape. Places non-sticky portion under neck

14. Suction mouth and throat if needed. Removes pooled secretions

15. Swab mouth with moisturizer and mouthwash. Freshens mouth and removes microorganism
16. Apply petroleum jelly to lips. Decreases dryness of lips
17. Position client in good alignment and for comfort. The patient’s position should be changed frequently to promote drainage and
 body kept in good alignment to prevent postural deformity as contractures
facilitates comfort

18. Position client in good alignment and for comfort. The patient’s position should be changed frequently to promote drainage and
body kept in good alignment to prevent postural deformity as contractures
facilitates comfort

19. Evaluate respirations. To determine effectiveness of procedure

20. Raise side rails and place call light within reach. Ensures safety; permits communication
21. Remove gloves and perform hand hygiene. Hand hygiene deters the spread of microorganisms
PERFORMED
ACTION RATIONALE REMARKS
YES NO
FOR ENDOTRACHEAL TUBE INSERTION
1. Assess airway and note landmarks, swelling, and To prevent aspiration
deformities.  Remove dentures. Assess tongue size, dental
obstruction, visibility of oropharynx, degree of neck
mobility. Maintain cervical spine stability as much as
possible.
2. Open airway by suctioning or manually extracting foreign Allows visualization of areas
material. Apply chin lift and jaw thrust.
3. Do Heimlich maneuver as needed. Allow visualization
4. Pre oxygenate with 100% non-rebreather or bag-valve- To monitor respirations and gas exchange; tachycardia; bradycardia
mask.  Keep pulse oximeter greater than 95% at all times.
5. Position patient into “sniffing position” if possible; restrain To prevent aspiration
as needed.
6. Standing at the supine patient’s head, gentle insert Working with the dominant hand prevents complication and promote comfort
laryngoscope blade with left hand.  Use suction as while performing necessary interventions
necessary with right hand.  The laryngoscope (size 3 for a
woman, size 4 for a man) is introduced into the right hand
side of the mouth (it is held by the left hand). The tongue is
swept to the left and the tip of the blade is advanced until a
fold of skin / cartilage is visualized at twelve o’ clock. This
is the epiglottis, and this sits over the glottis (the opening
of the larynx) during swallowing.
ACTION RATIONALE PERFORMED REMARKS
 YES NO
7. Visualize glottic opening/vocal cords. To assess for problems and aspirations
8. Advance endotracheal tube with right hand through To prevent damage of the tracheal tract
cords. The tip of the endotracheal tube is advanced through
the vocal cords and once the cuff has passed through, one
stops advancing. The tube is secured at this level.
9. Remove the stylet. To allow functioning of the ETT

10. Inflate endotracheal tube cuff with 5 – 10 cc air via syringe. To anchor endotracheal tube

11. Ventilate the patient with bag and oxygen. Avoid hypoxia and bradycardia

12. Confirm the tube placement with chest auscultation, CO2 Avoid trauma of the carina and ensuring that tube is not place along the
monitor and chest x-ray. Be careful that you have not esophagus
advanced too far: a normal male rarely requires a tube to be
advanced more than 23cm, a female 21cm.

Documentation:
 Document the size and type of NG tube that was inserted and the measurement from tip of the nose to the end of the exposed tube.
 Document the results of the x-ray that was taken to confirm the position of the tube, if applicable.
 Record a description of the gastric contents, including the pH of the contents.
 Document the naris where the tube is placed and the patient’s response to the procedure.
 Include assessment data, both subjective and objective, related to the abdomen.
 Record the patient teaching that was discussed.

 Items for Evaluation:

● Understands communication
● Appropriate preparation and pre-treatment
● Successful airway management
● Understands and manages complications
● Proper documentation in the medical record

Learner’s Reflection: (What did you learn most of the activity? Instructor’s Comments:
What is its impact to you?)
 As a nurse, it is important to determine the special considerations
that must be taken because we are dealing with various patient.
Proper assessment must be done in order to avoid any problems and
complications during the procedure proper. I also learn that in
performing this procedure our patient must be unconscious.

References:
Lynn, P. (2011). Taylor's Clinical Nursing Skills: A Nursing Process Approach. 3 rd Edition. Philadelphia: LWW
Smith-Temple, J & Johnson, J.Y. (2006). Nurses’ Guide to Clinical Procedures. 5 th Edition. Philadelphia: LWW.
Hilton, P.A. (2004). Fundamental of Nursin Skills. Philadelphia: Whurr Publishers Ltd.
Mills, E. J. (2004). Nursing Procedures. 4th Edition. Philadephia: LWW