Airway management

An open airway is essential for oxygenation of the body. In an emergency situation,

providing a patient airway is the top priority. If the client cannot get oxygen, the
function of any other body system is superfluous. Maintaining an open airway for the
client is a critical nursing function.

Airway management may be indicated in patients with loss of consciousness, facial or

oral trauma, aspiration, tumor, infection, copious respiratory secretions, respiratory
distress, and the need for mechanical ventilation.

Types of Airways

1. Oropharyngeal airway—curved plastic device

inserted through the mouth and positioned in the
posterior pharynx to move tongue away from
palate and open the airway.
2. Nasopharyngeal airway —soft rubber or plastic
tube inserted through nose into posterior pharynx.
3. Laryngeal mask airway—composed of a tube tracheostomy
with a cuffed masklike projection at the distal tube
end; inserted through the mouth into the pharynx;
seals the larynx.
4. Endotracheal tube—flexible tube inserted
Endotracheal tube
through the mouth or nose into the trachea.
5. Tracheostomy tube—firm, curved artificial
airway inserted directly into the trachea through
a surgically made incision.

Laryngeal
mask airway

page 1 of 5
 Equipment Needed
• Disposable gloves Pharyngeal airway sizes
• Ambu bag Nasopharyngeal Oropharyngeal
• Appropriate-size mask Large adult 8.0 – 9.0 ID* 100 mm
• Suction equipment Medium adult 7.0 – 8.0 ID 90 mm
• Stethoscope Small adult 6.0 – 7.0 ID 80 mm
• Water-soluble lubricant *ID : internal diameter
• Oxygen source
• Oropharyngeal airway
• Nasopharyngeal airway

Implementation

Action
Pharyngeal airway
1. Wash hands
2. Apply clean gloves. Put on mask,
eyewear, and gown if there is the risk of
vomiting or contact with blood or emesis.
3. Ensure that the mouth and pharynx are
cleared of secretions, blood, or vomit
using a suctioning catheter.
4. Nasopharyngeal airway insertion:
• Lubricate the nasopharyngeal airway
with water-soluble lubricant.
• Gently insert nasopharyngeal airway
close to the midline of the nostril along
the floor into the posterior pharynx behind
the tongue. Rotate the tube slightly if
resistance is encountered.
Rational
1. Reduces the transmission of
microorganisms.
2. Universal precautions when in contact
with bodily fluids.
3. Reduces the potential for aspiration
4.
• Ensures smooth introduction of airway past
tissues.
• Ensures proper placement and minimal
trauma to pharynx and surrounding
structures.

page 2 of 5
5. Oropharyngeal airway insertion:
• Gently insert oropharyngeal airway by
turning it upside down (into a U shape)
and sliding it into the mouth.
• As you continue to insert the airway,
rotate it so the ends of the U turn
downward into an arch shape after it
transverses the oral cavity and approaches
the posterior wall of the pharynx.
6. Maintain head slightly tilted back with
chin elevated.
7. Ensure that the airway is in proper
position by visually inspecting the mouth
and auscultating the lungs.
Ventilating the Client with an Ambu Bag
1. For the client who is unconscious and
not intubated:
• Assess appropriateness of use of Ambu
bag and need for mask or immediate
intervention with intubation.
• Clear oral cavity of vomit, mucus, or
other debris.
• Insert an oropharyngeal airway.
• Position client using either the head-tilt/
chin-lift method, or in the case of
suspected or potential cervical spine
injury, use the modified jaw thrust
maneuver.
page 3 of 5
5. Ensures proper placement and minimal
trauma to pharynx and surrounding
structures.
6. Ensures the airway remains patent.
7. The external part of the airway should be
at the entrance to the mouth. The airway
should curve over the tongue in alignment
with the tongue, in the center of the mouth.
Clear breath sounds should be heard on
auscultation.
1.
• Some clients presenting with facial injuries
will not be appropriate for use of Ambu bag
with mask, and an endotracheal tube must be
placed.
• Opens airway; helps prevent aspiration into
lungs.
• Assists in maintaining airway patency and
preventing the tongue from falling back into
the oropharynx.
• The modified jaw thrust maneuver
maintains the head in a neutral position if a
cervical spine injury is suspected.
• Position Ambu bag over the client’s nose • A proper seal ensures adequate ventilation.
and mouth using the nondominant hand.
The thumb and index finger are used to
stabilize the seal between the mask and
the client’s face, while the remaining
fingers maintain head position.

• The dominant hand is used to deliver • Provides adequate oxygenation per

breaths to the client. Breath rate is cardiopulmonary resuscitation protocol.
administered according to
cardiopulmonary resuscitation protocol.
• The chest is assessed to verify adequate • Verifies patent airway and adequacy of
inspiratory flow. manual ventilatory support.
• Assess for the need to insert a • Manual ventilation may force air into the
nasogastric tube. stomach and the client may vomit and
aspirate secretions. A nasogastric tube
decompresses the air in the stomach.
• Suction as necessary. • Suctioning maintains a patent airway and
prepares the oropharyngeal cavity for
intubation if necessary.
2. For the client with an existing 2.
endotracheal or tracheostomy tube
requiring suctioning or transfer:
• Remove the current mechanical • Opens airway for Ambu bag use.
ventilation system.
• For transfer, attach Ambu bag to • Provides hyperinflation and increases O2
endotracheal or tracheostomy tube and levels, preventing hypoxia, and decreases
compress bag to administer one breath CO2 levels prior to suctioning.
every 3–5 seconds. Compress the
reservoir 20 times per minute to mimic a
normal breathing pattern.
• The Ambu bag may be compressed with • Maintenance of artificial airway is of
two hands if the existing airway tube is paramount importance with the use of an
stable and the client is not fighting the Ambu bag.
procedure; otherwise, the nurse may have
to use the dominant hand to compress the
Ambu bag while stabilizing the airway
tube during the procedure.
• For suction, instill normal saline as per • Normal saline is used to loosen secretions
agency protocol (approximately 5–10 ml and mucous plugs as well as stimulate cough.
depending on size of client and qualified
practitioner order).
page 4 of 5
• Suction the client, reattach the Ambu
bag. Repeat the three preceding steps.
• End the procedure with administration of
several breaths before reconnecting client
to mechanical ventilatory support
.• The chest is assessed to verify air flow.
3. Ongoing assessment to determine need
to discontinue procedure as evidenced by:
• Endotracheal or tracheostomy secretions
minimal and artificial airway patent
• Client no longer coughing.
• Stable vital signs.
• Client no longer dusky or cyanotic.
• Return of spontaneous respirations.
4. Remove Ambu bag and reattach client
to mechanical ventilation system.
5. Reposition client and return bed and
guard rails to original position.
6. Clean supplies and dispose of
disposable supplies used during
procedure.
7. Document tolerance of procedure.
page 5 of 5
• Removes secretions and mucous plugs, and
maintains patency of artificial airway.
• Replaces O2 and prevents atelectasis.
•Verification of adequate inspiratory effort.
3. Ongoing assessment is critical in
determining improvement or deterioration in
the client’s clinical status.
• Provides information on tolerance of the
procedure.
4. Maintains ventilatory and oxygen support.
Additionally, an unconscious client who
required cardiopulmonary resuscitation will
probably be intubated and placed on
mechanical ventilatory support.
5. Promotes client comfort and safety.
6. Assists in the prevention of infection
transmission.
7. Provides information on airway patency
and client knowledge and comfort with
procedure.