Airway management is a process used to ensure that a patient is able to breathe and perform gas exchange. It involves suctioning, airway maintenance, establishing an artificial airway, and extubation.
It goes without saying that this is a very important topic in the field of respiratory care.
In this article, we will provide an overview of airway management and break it down in a way that’s easy to learn and understand. We included helpful practice questions for your benefit as well.
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What is Airway Management?
Airway management is the process of maintaining ventilation so that gas exchange can occur. This allows a patient to take in oxygen while removing carbon dioxide.
This is important because we need to keep a patient’s upper airway free and clear of foreign substances so that air can flow into and out of the lungs.
Types of Airway Management
Airway management involves multiple medical procedures, including:
- Endotracheal suctioning
- Sputum sampling
- Artificial airways
- Intubation
- Emergency surgical airways
- Securing the airway
- Confirming proper tube placement
- Secretion clearance
- Tracheostomy care
- Troubleshooting airway emergencies
- Extubation
These are examples of the common procedures that are involved in the process of airway management. Respiratory therapists are involved every step of the way. Again, that is why this is such an important topic.
What is an Artificial Airway?
An artificial airway is a tube that is inserted into the patient’s trachea in order to maintain breathing and ventilation.
This is necessary when a patient is unable to maintain their own airway or if they are at risk of aspirating. In this case, an artificial airway is used to establish a link between the patient and the mechanical ventilator. There are three primary types:
- Endotracheal tube
- Tracheostomy tube
- Pharyngeal airways
Each type has different uses and advantages. However, in order to function properly, they must be inserted and maintained correctly, which is the job of a respiratory therapist.
Endotracheal Tube
An endotracheal tube is a small, flexible tube that is inserted through the nose or mouth into the trachea. This is necessary to establish an artificial airway for a patient in need of mechanical ventilation.
The endotracheal tube is secured in place with tape or a tying device, and the insertion process is known as intubation.
Tracheostomy Tube
A tracheostomy tube is a small, flexible tube that is inserted through an incision in the neck and into the trachea. This is generally done when a patient is unable to tolerate intubation or if they are in need of long-term ventilatory support.
After a tracheostomy tube has been inserted, it is the responsibility of the respiratory therapist to maintain the tube in place and keep the incision site clean. This is known as tracheostomy care.
Pharyngeal Airways
Pharyngeal airways are small tubes used to prevent obstructions and extend only into the pharynx. There are two types:
- Nasopharyngeal airway
- Oropharyngeal airway
A nasopharyngeal airway is a small tube that is inserted into the nasal passage of patients who require frequent nasotracheal suctioning.
An oropharyngeal airway is a small tube that is inserted into the mouth of an unconscious patient to prevent the tongue from causing an obstruction.
Intubation
Intubation is the process of inserting a tube into the trachea in order to establish an airway and facilitate breathing support via mechanical ventilation. This creates a link between the patient and the ventilator so that gas exchange can occur.
During an intubation procedure, patients are administered anesthesia and a muscle relaxant in order to minimize discomfort and relax the muscles of the airways.
A laryngoscope blade is used to open the mouth in order to visualize the vocal cords. Then, a flexible plastic tube is inserted through the patient’s mouth or nose, through the vocal cords, and into the trachea.
The tube can be secured by inflating the small cuff that surrounds the tube with air in order to provide stability and help keep it in place.
The process of intubation is typically the same in patients of all ages. The only difference is in the size of the equipment used during the process of insertion.
For example, pediatric patients will require a much smaller endotracheal tube than adult patients. Male patients may sometimes require a larger tube than female patients.
The physical insertion of the endotracheal tube is a procedure that requires a trained and skilled professional, which is why it’s most commonly performed only by doctors and respiratory therapists.
Airway Suctioning
Airway suctioning is the process of clearing secretions from a patient’s airway. This is typically done using a suction catheter, which is a thin, flexible tube with a small opening at the end.
The catheter is inserted through the nose or mouth and down into the airway. It uses negative pressure from a vacuum source to suction mucus and secretions from the patient’s airways.
Suctioning is an important part of respiratory care, as it helps to keep the airway clear and free of obstructions so that breathing can occur. It is performed on a regular basis by respiratory therapists and nurses.
Extubation
Intubation and mechanical ventilation are only temporary for most patients. Therefore, at some point, the artificial airway must be removed, which is a procedure known as extubation.
The decision to extubate a patient is based on many factors, including:
- Ability to protect their airway
- Adequate respiratory function
- Ability to manage secretions
- Adequate oxygenation
- Stable hemodynamic status
- Ability to cooperate with the medical team
The respiratory therapist or physician will generally perform the extubation procedure. This involves oxygenating the patient, deflating the cuff, removing the tube, suctioning secretions, and assessing and closely monitoring the patient.
Airway Management Practice Questions:
1. When is an artificial airway required?
When the patient’s natural airway can no longer facilitate ventilation
2. What are the contraindications of an artificial airway?
When the patient has a Do Not Resuscitate (DNR) order
3. What are the possible complications of an artificial airway?
Trauma to the nose, mouth, tongue, pharynx, larynx, vocal cords, trachea, or esophagus; aspiration; or infection
4. What does a pharyngeal airway do?
It prevents airway obstruction by keeping the tongue pulled forward and away from the posterior pharynx
5. Does the nasopharyngeal airway enter the trachea?
No, it extends only into the pharynx.
6. Which artificial airway is best to help with suctioning?
Nasopharyngeal airway
7. What artificial airway can be used as a bite block?
Oropharyngeal
8. Which artificial airway is mainly used in emergency life support?
Pharyngeal airways
9. What is an endotracheal tube?
An artificial airway that is placed in the trachea in order to support mechanical ventilation
10. What is intubation?
The process of placing an artificial airway into the trachea
11. Do pharyngeal airways extend only into the trachea?
No, they only extend into the pharynx.
12. What is orotracheal intubation?
When the tube passes through the mouth into the trachea, as opposed to being passed through the nose
13. What is nasotracheal intubation?
When the tube passes through the nose into the trachea, as opposed to being passed through the mouth
14. What are the two types of tracheal airways?
Endotracheal and tracheostomy tubes
15. Are tracheostomy tubes inserted surgically?
Yes
16. What is the purpose of the angle of the bevel on an endotracheal tube?
It minimizes mucosal trauma during insertion.
17. What is the purpose of inflating the cuff of an endotracheal tube?
It protects from aspiration and helps provide positive pressure ventilation.
18. What are the three areas of skill for respiratory therapists in airway management?
(1) Insert and maintain artificial airways, (2) Be proficient in airway clearance, and (3) Assist physicians in performing procedures related to airway management
19. What are the two categories of airways?
Pharyngeal and tracheal airways
20. What are the two types of pharyngeal airways?
Oropharyngeal airway (OPA) and nasopharyngeal airway (NPA)
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21. What are oropharyngeal airways made of?
Metal, plastic, or rubber
22. What are the indications of an oropharyngeal airway?
(1) To prevent an airway obstruction by the tongue, (2) To be used as a bite block, and (3) To increase the effectiveness of bag/mask ventilation
23. What is a contraindication of an oropharyngeal airway?
A conscious patient with an intact gag reflex
24. What are some complications of oropharyngeal airways?
Laryngospasm/cough, vomiting/aspiration, airway obstruction, lip or tongue damage, and dental damage
25. How is an oropharyngeal airway sized?
From the angle of the jaw to the corner of the mouth
26. What are the most common oropharyngeal airway sizes for adults?
80 and 90
27. The nasopharyngeal airway (NPA) is also known as?
Nasal trumpet
28. Where is the nasopharyngeal airway inserted?
It is inserted into the nose and rests behind the tongue, just above the epiglottis.
29. What are the indications for a nasopharyngeal airway?
(1) To increase the effectiveness of bag/mask ventilation, (2) To aid with suctioning and bronchoscopy, (3) For the management of facial anomalies, and (4) To eliminate the risk of oral damage
30. What are the complications of using a nasopharyngeal airway?
Laryngospasm/cough, nosebleeds, sinus infections, and damage to the turbinates
31. The nasopharyngeal airway is tolerated best by what type of patient?
A conscious patient
32. What are the steps for placing a nasopharyngeal airway?
(1) Perform a head-tilt, (2) Use water-soluble lube, (3) Slowly advance the airway until it rests above the epiglottis, (4) Confirm correct placement using a tongue depressor
33. What are some indications for tracheal intubation?
(1) To bypass an upper airway obstruction, (2) To protect the airway from aspiration, (3) To apply positive pressure ventilation, (4) To aid clearance of secretions, and (5) To deliver high oxygen concentrations
34. Can you instill drugs directly down an endotracheal tube?
Yes, you can generally instill a dose that is twice the normal dose.
35. What drugs can be instilled down an endotracheal tube?
The drugs that can be used for direct instillation include narcan, atropine, valium/versed, epinephrine, and lidocaine. Remember NAVEL as an easy way to memorize these medications.
36. What are the advantages of oral intubation?
(1) It’s faster, easier, less traumatic, and more comfortable for the patient, (2) Larger tubes can be tolerated, (3) It makes suctioning easier, (4) There is less airflow resistance, (5) It provides a decreased work of breathing, (6) There is a decreased risk of the tube kinking, and (7) It helps avoid nasal and paranasal complications
37. What are the disadvantages of oral intubation?
There is a greater risk of self-extubation, mainstem intubation, tube occlusion from biting, injury to the oral structures, and an increased risk of retching, vomiting, and aspiration.
38. What is the preferred method of intubation during CPR?
Oral
39. How is the endotracheal tube size measured?
It’s measured in millimeters on the inside diameter.
40. What do the centimeter markings on the endotracheal tube indicate?
They indicate the placement of the tube.
41. What is the purpose of using a stylet during intubation?
It gives the tube more rigidity.
42. What are the advantages of nasal intubation?
It provides greater comfort, less salivation, improved swallowing, more communication, no need for oral care, helps to avoid occlusion from biting, creates less damage to oral structures, provides better stabilization, reduces the risk of mainstem intubation, and does not require muscle relaxants or sedatives.
43. What are the disadvantages of nasal intubation?
There are nasal/paranasal complications, it is more difficult to perform, spontaneous breathing is required for the procedure, a smaller tube is necessary, suctioning is more difficult, there is an increased airflow resistance, there is an increased work of breathing, and it is more difficult to pass a bronchoscope.
44. What is the name of a curved laryngoscope blade?
Macintosh
45. Would you want to use the Macintosh blade for neonates?
No, a Miller blade is preferred in infants.
46. Where is the Macintosh blade designed to fit?
It is designed to fit into the vallecula so that it indirectly lifts the epiglottis.
47. What is the name of the straight laryngoscope blade?
Miller
48. Where is the Miller blade designed to fit?
It is designed to fit into the epiglottis.
49. Which laryngoscope blade is best for neonates?
Miller (straight blade)
50. What is the purpose of the Murphey’s eye?
It allows collateral ventilation.
Oxygen flowmeter and tubing, manual resuscitator, suction setup, oropharyngeal airway, laryngoscope, endotracheal tube, stylet, stethoscope, tape, 10 cc syringe, towels for positioning, gloves, gowns, masks, eyewear, and a CO2 detector
52. Where should the tip of the endotracheal tube rest?
It should rest 2-4 cm above the carina.
53. What should the tube depth of the ET tube be for the adults?
21-23 cm at the lip
54. How long should you hyperinflate and
2-3 minutes
55. What is an extra piece of equipment you may need for nasal intubation?
Magill forceps
56. What position should the patient be in for nasal intubation?
Direct – supine blind (fowlers position)
57. How do you confirm the
Auscultation, observation of chest movement, PetCO2, e
58. What is the most accurate way to confirm tube placement after intubation?
59. Should you use a chest x-ray to confirm tube placement after intubation?
No, it should only be used to determine the position of the tube.
60. When should you consider a tracheostomy?
When the ET tube will be inserted for more than seven days
61. What is the maximum recommended range for tracheal tube cuff pressure?
20-25 mmHg
62. Repeated connecting and disconnecting of a cuff pressure manometer to the pilot tube of a cuffed tracheal airway will do what?
It will decrease the cuff pressure.
63. What type of endotracheal tube should the respiratory therapist use when a unilateral lung disease occurs, and independent lung ventilation is needed?
A double-lumen endotracheal tube
64. When is an uncuffed tracheostomy tube used?
When there is no major concern about aspiration
65. What is the fenestrated tracheostomy tube?
A type of tracheostomy tube that can help facilitate speech
66. What complications occur after extubation?
67. What is the number one complication post-extubation?
Hoarseness
68. How do you prevent airway trauma?
Use sedation when necessary, use nasal tubes instead of oral tubes, use correctly sized tubes, avoid changing tubes, avoid unnecessary coughing, and limit the cuff pressure.
69. What is the process of airway maintenance?
(1) Secure the tube and maintain proper placement, (2) Provide cuff care, (3) Aid in secretion clearance, (4) Ensure humidification, (5) Minimize the possibility of infection, (6) Provide patient communication, and (7) Troubleshoot emergencies
70. What do you need in order to secure an endotracheal tube?
Tape, velcro attachments, harness, and bite block
71. What do you need in order to secure a tracheostomy tube?
Velcro attachments or ties
72. What values should you record for the positioning of an endotracheal tube?
You should record the size of the tube and the positioning, which is recorded in centimeters.
73. Unplanned extubation occurs in what percentage of intubated patients?
Unplanned extubation occurs in 2-13% of patients. The primary contributing factor is a lack of secure placement.
74. What is an easy way to remember what equipment is needed during intubation?
You can remember SOAPME, which stands for: suction equipment, oxygen, airway equipment, position the patient, monitors, and esophageal detectors.
75. What is the normal range for cuff pressure?
20-30 cmH2O
76. When maintaining cuff pressure, it is important to?
Keep the cuff pressure below the tracheal capillary perfusion pressure
77. How can you measure cuff pressure?
You can use a pressure manometer to measure cuff pressure.
78. What are some emergency airway situations?
Tube obstructions, cuff leaks, and accidental extubations
79. What are examples of a tube obstruction?
Kinking or biting, herniation of the cuff over the tube, jamming
80. What are the
Respiratory distress, changes in breath sounds, and air movement through the mouth
81. How do you fix kinking of the endotracheal tube?
Reposition the head/neck
82. How do you fix biting of the endotracheal tube?
Use an oropharyngeal airway or bite block
83. What should you do in the case of a herniated cuff?
Deflate and re-inflate the cuff; then you can try to pass a suction catheter to determine if the cuff is herniated
84. What should you do if the tip of the endotracheal tube is on the tracheal wall?
Reposition the airway and the patient’s head or neck
85. What should you do if there is a mucus plug?
Lavage, try to pass a suction catheter, and then resort to extubation
86. What should you always do prior to extubation?
Suction the patient
87. What is extubation?
The procedure of removing an endotracheal tube
88. What are some indications for extubation?
The patient can maintain their upper airway patent, protect their lower airway from aspiration, clear secretions from the lower respiratory tract, and breathe without mechanical ventilation
89. What is the failure rate for extubation?
5-15% of cases are failures
90. A practitioner who performs extubation should also be able to do what?
Intubate
91. What can be used to maintain a stoma?
Tracheal button
92. How is the laryngeal mask airway (LMA) inserted?
It is blindly inserted.
93. How is the esophageal obturator (EOA) inserted?
It is inserted into the esophagus
94. How does an endotracheal tube exchanger work?
It is inserted through the ET tube, and then the ET tube is withdrawn and removed. A new ET tube can be slipped over the tube exchanger and threaded down into the proper location.
95. What are the supplies needed for tracheostomy care?
Suction supplies, oxygen therapy, hydrogen peroxide, sterile dressings and ties, sterile water, and a new inner cannula (or supplies to clean a reusable one).
96. What can you give to reduce inflammation post-extubation?
Decadron
97. What should the patient’s FiO2 be in order to proceed with extubation?
40% or less
98. Tracheal airways increase the incidence of pulmonary infections for all of the following reasons except:
Lower levels of humidification
99. What types of obstructions can occur in a natural airway?
(1) Soft/tissue (tongue) obstruction, (2) Foreign body, (3) Supraglottic or subglottic edema, and (4) Thick secretions
100. What are the signs of a complete obstruction in a natural airway?
(1) Paradoxical chest movement, (2) Inability to vocalize, (3) Marked use of accessory muscles, (4) Nasal flaring, and (5) Severe anxiety or agitation
101. What maneuvers can help establish patency in a natural airway?
(1) Modified jaw thrust and (2) Head-tilt/chin-lift
102. What is a modified jaw thrust?
It is a modified technique of moving the jaw that aims to avoid head-extension and is good for suspected neck trauma patients. It is done by pushing the mandibular process to extend the jaw and open the airway.
103. How do you perform the head-tilt/chin-lift maneuver?
It is done by lifting the front edge of the patient’s jaw with one hand while pushing the forehead upward. You should not use this when there is a suspected neck or spinal cord injury.
104. What is the procedure for extubation?
(1) Clear the airway by suctioning below and above the airway, (2) Explain the procedure to the patient, (3) Remove the air from the cuff, (4) Have the patient inhale and hold their breath at maximum inspiration while removing the tube, (5) Instruct the patient to cough and expectorate, (6) Perform suctioning if needed
105. What is the purpose of suctioning while an artificial airway is in place?
To remove secretions, promote expectoration of secretions (cough), or collect a sputum sample
106. What is the procedure for suctioning while an artificial airway is in place?
Pre-oxygenate the patient with 100% oxygen before and after suctioning for 1-3 minutes. The procedure should be sterile, and you should suction for no longer than 15 seconds. Stop suctioning if the patient shows signs of distress.
107. What are the hazards of suctioning while an artificial airway is in place?
Cardiac changes can occur due to vagal stimulation (e.g., bradycardia or hypotension). Hypoxemia can also occur as oxygen is suctioned away from the patient.
108. To ensure adequate humidification for a patient with an artificial airway, inspired gas at the proximal airway should be 100% saturated with water vapor, and at what temperature?
32 to 35 degrees C
109. How do we determine the size of a nasopharyngeal airway?
The outside diameter of the airway should be equal to the inside diameter of the patient’s external nares. The length of the airway is measured from the
110. How do you insert an oropharyngeal airway?
It should be inserted opposite of its anatomic shape. Therefore, you can insert it upside down to the back of the throat and then rotate it into its correct position.
111. How do you insert a nasopharyngeal airway?
It should be inserted in the direction of its anatomical shape using a water-soluble lubricant.
112. What is the minimal leak technique (MLT)?
It is a technique that involves slowly injecting air into the cuff during positive pressure inspiration until the leak stops.
113. How do you troubleshoot a laryngoscope?
If the light doesn’t work, you can tighten the bulb, check the handle attachment, change the blade, or change the batteries.
114. What are the normal blade sizes?
Adult: size 3; Pediatric: size 2; Term infant: size 1; Pre-term infant: size 0
115. What is a stylet?
It is used to aid in oral intubations only and helps shape the tube for easier insertion.
116. What are Magill forceps?
They are used to aid in nasal intubation and are inserted into the mouth to lift the tube into the trachea.
117. What are the normal endotracheal tube markings?
For oral intubation, the tube is inserted 21-25 cm at the lip. For nasal Intubation, the tube is inserted 26-29 cm at the nares.
118. What is a double-lumen tube?
It’s an artificial airway with two independent lumens of different lengths. The longer tube is inserted in either the left or right mainstem bronchus. The shorter tube is placed in the trachea above the carina. Each Lumen can ventilate one lung separately, or they can be connected via wye and share the same ventilation source.
119. Where is a laryngeal mask airway (LMA) positioned?
It is positioned directly over the opening of the trachea (hypopharynx).
120. What three methods can be used to determine the correct position of an ET tube?
(1) Look for bilateral chest expansion during inspiration, (2) Auscultation of the patient’s chest should reveal bilateral breath sounds, and (3) The chest x-ray should show the radiopaque line on the endotracheal tube
121. How can a respiratory therapist maintain airway patency?
Suctioning
122. When checking for proper placement of an endotracheal tube in an adult patient on a chest radiograph, it is noted that the distal tip of the tube is 2 cm above the carina. Which of the following actions would you recommend?
Withdraw the tube 2 to 3 cm
123. When checking for proper placement of an endotracheal or tracheostomy tube on a chest radiograph, how far above the carina should the distal tip of the tube be positioned?
3 to 6 cm
124. What size laryngoscope blade is used for adult patients?
Size 3
125. What size laryngoscope blade is used for term infants?
Size 1
126. What is the approximate endotracheal tube size for a pre-term infant?
2.5-3.0 mm
127. What is the approximate endotracheal tube size for a full-term infant?
3.0-3.5 mm
128. What is the appropriate endotracheal tube size for adults?
Males: 8.0-9.0mm; Females: 7.0-8.0 mm
129. A patient receiving mechanical ventilation is being transported to radiology for a CT scan. The respiratory therapist is arranging equipment when the low volume alarm begins to sound. She also notes that the oral endotracheal tube is taped at the 28 cm mark. Where should the tube actually be located?
Between 21-25 cm
130. Why should the endotracheal tube be removed at peak inspiration?
To prevent vocal cord damage
131. What should you do if the patient self-extubates?
Alert the physician and re-intubate the patient
132. What is a complication of extubation?
Post-extubation stridor and a sore throat, which can be managed with humidity, oxygen, and/or racemic epinephrine
133. When is a tracheostomy preferred over endotracheal intubation?
It is the preferred method of providing an airway for patients who require long-term ventilation.
134. What are two possible immediate complications of a tracheostomy procedure?
Bleeding and a possible pneumothorax
135. What are two possible late complications of a tracheostomy procedure?
Infection and hemorrhage
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136. When should a tracheostomy tube cuff be inflated?
It should be inflated if the patient is eating or if they are receiving positive pressure ventilation.
137. When is a fenestrated tracheostomy tube recommended?
It is used for weaning and temporary mechanical ventilation with an inner cannula.
138. What are the characteristics of a standard tracheostomy tube?
They are often white, made of plastic, and may have an inner cannula for easy cleaning.
139. What should you do to the cuff of a tracheostomy tube when using a tracheal speaking valve?
The cuff must be deflated.
140. What is the most commonly used airway for ventilating a patient with a manual resuscitator?
Oropharyngeal airway
141. Which of the following techniques or procedures should be used to help minimize infection of a tracheostomy stoma?
Regular aseptic stoma cleaning, adherence to sterile techniques, and regular changing of the tracheostomy dressings
142. What does LMA stand for?
Laryngeal Mask Airway
142. Oropharyngeal airways are indicated for what types of patients?
Unconscious patients
143. Can the incorrect placement of an oropharyngeal airway (OPA) push the tongue further back into the pharynx and make an obstruction worse?
Yes
144. What should you do if you encounter resistance upon insertion of a nasopharyngeal airway in the right nare?
Try the left nare
145. What is the most common airway maneuver that can be used to ventilate an apneic patient during CPR?
Head-tilt/chin-lift
146. What is the proper way to estimate the appropriate length of a nasal airway?
Measure from the patient’s earlobe to the tip of the nose
147. When is the jaw thrust technique indicated to help maintain an open airway?
During most CPR efforts
148. When should a laryngeal mask airway be used?
It should be used for short-term ventilation of an unconscious patient.
149. A physician is concerned about the potential for tracheal damage due to tube movement in a patient who recently underwent tracheostomy and is now receiving 40% oxygen through a T- tube. What would be the best way to limit the tube movement in this patient?
Switch from the T-tube to a tracheostomy collar
150. What is a hazard of the insertion of an oropharyngeal airway?
Vomiting
151. What is the position of a correctly sized and properly inserted oropharyngeal airway?
The distal tip should be at the base of the tongue, and the flange should be outside the teeth.
152. A patient has been receiving positive pressure ventilation through a tracheostomy tube, and there was evidence of both recurrent aspiration and abdominal distention. There was also minimal air leakage around the tube cuff. What is the most likely cause of this problem?
Tracheoesophageal fistula
153. What is a stoma?
A hole in the trachea without a tube in place
154. What are the complications of a tracheostomy?
Bleeding, pneumothorax, air embolism, subcutaneous emphysema, infection, hemorrhage, and tracheal stenosis.
155. What is a Passy-Muir speaking valve?
It’s a one-way valve that attaches to the 15 mm adaptor and allows for speech and secretion management. It allows air to enter only during inspiration. The blue-colored ones are used with ventilators. The white ones are for spontaneously breathing patients.
156. What is a tracheostomy button used for?
It’s used to aid in weaning from a tracheostomy tube, and it helps keeps the stoma open.
157. What does a tracheostomy button look like?
It’s a short, soft, and hollow tube that fits in the stoma in place of a tracheostomy tube.
158. A patient is being evaluated for tracheal damage sustained while having undergone prolonged tracheostomy intubation approximately three months earlier. The flow-volume loop demonstrates a fixed obstructive pattern. What is the most likely cause of the problem?
Tracheal stenosis
159. What are the methods for weaning from a tracheostomy tube?
Tracheostomy buttons, fenestrated tubes, progressively smaller tracheostomy tubes.
160. Tracheal stenosis occurs in as many as 1 in 10 patients after prolonged tracheostomy. Where does this stenosis usually occur?
The cuff site, the tip of the tube, and the stoma site
161. What is the biggest problem with an LMA?
Regurgitation during insertion
162. What is one of the most common causes of airway obstruction?
Tube obstruction
163. How do you know when there is an obstruction in the tube?
When the peak airway pressure on the ventilator increases
164. When will you need to remove the entire airway and replace it?
If all the other methods are not working.
165. Which airway is preferred during an emergency?
Oral
168. What should you do when weaning a tracheostomy patient?
Remove the inner cannula, deflate the cuff, and cap the tracheostomy
169. What types of artificial airways are inserted through the larynx?
Nasotracheal and orotracheal tubes
170. Compared with the oral route, the advantages of nasal intubation include all of the following except:
Reduced risk of kinking
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Decreased frequency of aspirations
172. What is the purpose of the additional side port on most modern endotracheal tubes?
To ensure gas flow if the main port is blocked
173. What is the purpose of the cuff on an artificial tracheal airway?
To seal off and protect the lower airway
174. What is the purpose of the pilot balloon on an endotracheal or tracheostomy tube?
To monitor cuff status and pressure
175. The removable inner cannula that is commonly incorporated into modern tracheostomy tubes serves what purpose?
It aids in routine cleaning and provides a patent airway should an obstruction occur.
176. Before beginning an intubation procedure, the practitioner should check and confirm the operation of what?
Laryngoscope light source, endotracheal tube cuff, and suction equipment
177. Which of the following statements are false about methods used to displace the epiglottis during oral intubation?
Levering the laryngoscope against the teeth can aid displacement
178. What is the most common sign associated with the transient glottic edema or vocal cord inflammation that follows extubation?
Hoarseness
179. After the removal of an oral endotracheal tube, a patient exhibits hoarseness and strider that do not resolve with racemic epinephrine treatments. What is most likely the problem?
Vocal cord paralysis
180. Which of the following injuries are NOT seen with tracheostomy tubes?
Glottic edema and vocal cord granulomas
FAQ
What are Retained Secretions?
Retained secretions are any secretions that remain in the airways of the lungs. This can be due to a variety of factors, including an inadequate cough, muscle weakness, impaired mucus clearance, and dehydration.
Secretions that are not cleared from the lungs can lead to respiratory infections, atelectasis, and pneumonia. Therefore, they should be removed by suctioning, which is a procedure that is performed by the respiratory therapist.
What is Sputum Sampling?
A sputum sample is a sample of the secretions that are coughed up from the lungs. This can be used to diagnose various lung diseases.
To obtain a sputum sample, a patient will be asked to cough up some of their secretions into a container. This can be done by coughing into a cup or by using a suction device.
What is an Emergency Surgical Airway?
An emergency surgical airway is a last resort when all other attempts at airway management have failed. For example, the patient’s physiological condition could make it difficult or impossible to perform intubation.
In this case, a transtracheal airway must be established by making an incision in the trachea and inserting a tube into the opening.
This is known as a cricothyroidotomy and is a life-saving procedure that should only be performed by trained medical personnel.
How to Secure an Artificial Airway?
Once an artificial airway has been established, it is important to secure it in place. This is done by inflating the cuff that is attached to the tube. The cuff creates a seal around the tube, which prevents air from leaking around the tube.
It should also be secured with tape or a tying device. This helps prevent the tube from being dislodged.
How to Confirm Endotracheal Tube Placement?
There are several ways to confirm that an endotracheal tube is in the correct location. These include:
- Auscultate the chest and abdomen
- Look for chest movement
- Check the tube length and position
- Use capnometry
- Use colorimetry
- Use ultrasound
- Order a chest x-ray
Each procedure can be performed immediately after intubation to confirm proper tube placement. However, the most accurate method of confirmation is using a chest x-ray. This will show the placement of the tube in the trachea.
Final Thoughts
Airway management is a critical subject in respiratory care. It’s important to understand the techniques of each procedure and learn about the various types of artificial airways.
This will allow you to provide the best possible care for your patients. We have a similar guide on the topic of intubation that I think you’ll find helpful.
Thank you so much for reading and, as always, breathe easy, my friend.
Written by:
John Landry, BS, RRT
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- Chang, David. Clinical Application of Mechanical Ventilation. 4th ed., Cengage Learning, 2013.
- Rrt, Cairo J. PhD. Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications. 7th ed., Mosby, 2019.
- Faarc, Heuer Al PhD Mba Rrt Rpft. Wilkins’ Clinical Assessment in Respiratory Care. 8th ed., Mosby, 2017.
- “Intubations and Airway Management: An Overview of Hassles through Third Millennium.” PubMed Central (PMC), Apr. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4411585.
- “Clinical Consensus of Emergency Airway Management.” PubMed Central (PMC), 1 Nov. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5721045.