ARTIFICIAL AIRWAYS

Artificial airways are inserted to maintain a patent air passage for clients
whose airway has become or may become obstructed. A patent airway is
necessary so that air can flow to and from the lungs. Four of the more
common types of airways are oropharyngeal, nasopharyngeal,
endotracheal, and tracheostomy.
Oropharyngeal Airways.
Place the client in a supine or semi-Fowlers position.
Apply clean gloves.
Hold the lubricated airway by the outer flange, with the distal end pointing
up or curved upward.
Open the clients mouth and insert the airway along the top of the tongue.
When the distal end of the airway reaches the soft palate at the back of the
mouth, rotate the airway 180 degrees downward, and slip it past the uvula
into the oral pharynx.
If not contraindicated, place the client in a side-lying position or with the
head turned to the side to allow secretions to drain out of the mouth.
The oropharynx may be suctioned as needed by inserting the suction
catheter alongside the airway.
Remove and discard gloves. Perform hand hygiene.
Do not tape the airway in place; remove it when the client begins to cough
or gag.
Provide mouth care at least every 2 to 4 hours, keeping suction available at
the bedside.
As appropriate for the clients condition, remove the airway every 8 hours to
assess the mouth and provide oral care. Reinsert the airway immediately.
Nasopharyngeal airways

Provide frequent oral and nares care, repositioning the airway in the other
naris every 8 hours or as ordered to prevent necrosis of the mucosa.

Nursing Interventions for Clients with Endotracheal Tubes

Perform hand hygiene before and after contact with the client. Wear gloves
when handling respiratory secretions or objects contaminated with
respiratory secretions.

 Assess the clients respiratory status at least every 2 hours, or more

frequently if indicated.
Frequently assess nasal and oral mucosa for redness and irritation. Report
any abnormal findings to the primary care provider.
Secure the endotracheal tube with tape or a commercially prepared
tracheostomy holder to prevent movement of the tube farther into or out of
the trachea.
Unless contraindicated, elevate the head of the bed 3045 degrees.
Using sterile technique, suction the endotracheal tube as needed to
remove excessive secretions.
Closely monitor cuff pressure, maintaining a pressure of 20 to 25 mmHg (or
as recommended by the tube manufacturer) to minimize the risk of tracheal
tissue necrosis.
Provide oral hygiene and nasal care every 2 to 4 hours.
Provide humidified air or oxygen because the endotracheal tube bypasses
the upper airways, which normally moisten the air.
If the client is on mechanical ventilation, ensure that all alarms are enabled
at all times because the client cannot call for help should an emergency
occur.
Communicate frequently with the client, providing a note pad or picture
board for the client to use in communicating.

Tracheostomy Care
Prepare the client and the equipment
o Assist the client to a semi-Fowlers or Fowlers position
o Suction the tracheostomy tube, if needed
Clean the inner cannula.
o Remove the inner cannula from the soaking solution.
o Clean the lumen and entire inner cannula thoroughly using the
brush or pipe cleaners moistened with sterile normal saline
o Rinse the inner cannula thoroughly in the sterile normal saline.
o gently tap the cannula against the inside edge of the sterile saline
container. Use a pipe cleaner folded in half to dry only the inside of
the cannula
Replace the inner cannula, securing it in place.

o Insert the inner cannula by grasping the outer flange and inserting
the cannula in the direction of its curvature.
o Lock the cannula in place by turning the lock (if present) into
position to secure the flange of the inner cannula to the outer
cannula.
Clean the incision site and tube flange.
o Using sterile applicators or gauze dressings moistened with normal
saline, clean the incision site.
o Hydrogen peroxide may be used (usually in a half strength solution
mixed with sterile normal saline
Apply a sterile dressing.
o Use a commercially prepared tracheostomy dressing of non raveling
material or open and refold a 4 4 gauze dressing into a V shape
Change the tracheostomy ties or Velcro collar.
o Change as needed to keep the skin clean and dry.
Remove and discard sterile gloves. Perform hand hygiene.