You are on page 1of 48

Nasopharyngeal Oropharyngeal

Nasotracheal Orotracheal Tracheostomy

 To guarantee patency of airway  To improve airway protection  To allow positive pressure ventilation  To facilitate suctioning

Nasopharyngeal airway

 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 of mandible

Indication
 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.

Contraindication
 Nasal trauma  Basilar Skull fractures  Deformities of the nose  Coagulation disorders

Hazards
Sinusitis Otitis media Gastric insufflation (if the airway is too long) Intubation of meninges (in case of head or facial trauma)  Occlusion of the airway by secretion  Tissue necrosis  Bleeding    

Oropharyngeal airway

Gudeal

 Berman

 Holds the tongue away from pharyngeal wall  Bite block after intubation  Size; lip to the angle of mandible  Inserted only in deep comatose patients

 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)

Indication
 Unconscious patients

Contraindication
 Oropharyngeal trauma  Conscious or semiconscious patients --------induce (vomiting and aspiration )

Hazards
 Oral trauma  Pressure necrosis (if left in place too long)  Gagging  Vomiting  Aspiration  Airway obstruction ( with improper insertion)

Use of Endotracheal tube


 To prevent airway obstruction  To facilitate suctioning  To provide mechanical ventilation  To protect the lower airway from foreign objects

at lips premature New born 1- 6 months 6 12 months 2 years 4 6 8 10 12 > 14 female > 14 male 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7 8

ET size10
11 11 12 13 14 15 16 16- 17 17- 18 18- 22 20 24 (21) 20 24 (23)

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

 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

 Pilot tube ------- (extends past proximal end of the tube and terminate with a pilot balloon and 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)

Contraindication
 Generally not addressed, but two important ones are  complete obstruction of the upper airway  Lack of person trained and experienced in tracheal intubation

Complication
        Bronchospasm Laryngospasm Hypoxemia Esophageal intubation/gastric distention Rupture of trachea/cuff Aspiration (blood,tooth ,gastric contents) Airway obstruction Sore throat, dysphasia

 Paralysis of vocal cords  Vocal cord adhesions  Tracheal stenosis  Laryngeal edema/ulceration  Ulceration of lips, mouth, pharynx  Tracheal bleeding

 Assemble and check equipment  Position the patient  Pre- oxygenate  Insert laryngoscope  Visualize and displace glottis  Insert tube  Assess tube position  Secure and stabilize airway

Intubation

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

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

 Ascultation of chest and epigastrium  Observation of chest movement  Tube length (cms of teeth)  Airway condensation  Capnometry/ copnography  Gastric contents

 Goals ;
   

Relief of upper air way obstruction Long term mechanical ventilation Acute / chronic neuromuscular conditions Brain injury

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 )

 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

 Tracheostomy tubes made from a plastic, such as PVC or silicone and also made of silver or stainless steel.  Several manufacturs also produce a fenestrated tube (or window)

 It has four parts ;----------- Inner cannula, outer cannula, obturator and cuff  The inner cannula can be removed to clean secretions 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.

Complication of Tracheostomy
          Hemorrhage Subcutaneous emphysema Obstruction Wound infection Recurrent laryngeal nerve damage Tracheal stenosis Dysphagia Tracheoesophageal fistula Subglottic edema Aspiration and atelectasis

 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

 Low volume High pressure cuff

bad

 High volume Low pressure cuff

good

 Optimal pressure ; 20 25 mm Hg  Capillary perfusion pressure 25 -30 mm Hg


 

Increased pressure --- ischemia and stenosis Decreased pressure --- microaspiration

 Remove inner cannula prior to humdification and suctioning  Wash inner cannula with saline and hydrogen peroxide  Wet gauze pads for continuous humdification  Home care

You might also like