ICU PROCEDURES: AIRWAY MANAGEMENT

ICU Procedures: Airway Management – Endotracheal Intubation, Tracheostomy Care and Suctioning procedures

Airway management is essential in critically ill patients to ensure proper oxygenation and ventilation. The following outlines key procedures in airway management: endotracheal intubation, tracheostomy care, and suctioning.

1. Endotracheal Intubation

Endotracheal intubation involves inserting a tube through the mouth or nose into the trachea to maintain an open airway and provide mechanical ventilation.

Procedure:

1. Preparation:
   • Gather equipment: laryngoscope, endotracheal tube (ETT), suction apparatus, bag-valve-mask, stethoscope, and monitoring devices.
   • Ensure the patient is adequately pre-oxygenated with 100% oxygen for 3–5 minutes.
   • Position the patient in a “sniffing” position (head tilted back slightly, neck extended).
2. Sedation and Paralysis:
   • Administer sedative (e.g., propofol) and paralytic (e.g., succinylcholine) agents to relax the patient and ease tube insertion.
3. Insertion:
   • Insert the laryngoscope into the patient’s mouth and visualize the vocal cords.
   • Gently pass the endotracheal tube through the vocal cords into the trachea.
   • Inflate the cuff on the ETT to seal the airway.
4. Confirmation:
   • Check placement by auscultating breath sounds on both sides of the chest.
   • Observe chest rise and fall.
   • Confirm with capnography or an X-ray if necessary.
5. Securing the Tube:
   • Secure the tube with tape or a securing device.
   • Connect the tube to a mechanical ventilator.

Nursing Considerations:

• Continuously monitor oxygen saturation, heart rate, and blood pressure.
• Watch for signs of improper placement or complications such as tube dislodgement, infection, or aspiration.

2. Tracheostomy Care

A tracheostomy is a surgically created opening in the neck into the trachea to provide an alternative airway for breathing.

Procedure:

1. Preparation:
   • Gather equipment: sterile gloves, cleaning solution (e.g., saline), new tracheostomy tube, suction catheter, gauze, and ties.
2. Cleaning the Stoma Site:
   • Wash hands and apply sterile gloves.
   • Remove the old dressing and inspect the stoma site for infection or irritation.
   • Clean the area around the stoma with sterile saline or a prescribed solution.
3. Inner Cannula Care:
   • If the tracheostomy tube has an inner cannula, remove it and clean it with saline.
   • Replace it with a new sterile inner cannula or the cleaned one.
4. Changing Tracheostomy Ties:
   • Change tracheostomy ties or holder to prevent skin breakdown.
   • Ensure the tube is secure but not too tight around the neck.
5. Dressing Application:
   • Place sterile gauze around the tracheostomy tube to keep the area clean and absorb secretions.
6. Observation:
   • Monitor for signs of infection, bleeding, or displacement of the tracheostomy tube.

Nursing Considerations:

• Ensure proper humidification of air to prevent thick secretions.
• Keep emergency equipment (e.g., suction, obturator, spare tracheostomy tube) at the bedside in case of accidental decannulation.

3. Suctioning

Suctioning is performed to remove secretions from the airway to prevent obstruction and maintain clear airways.

Procedure:

1. Preparation:
   • Gather equipment: suction machine, sterile suction catheter, sterile gloves, saline, and oxygen source.
   • Explain the procedure to the patient if possible.
2. Pre-Oxygenation:
   • Pre-oxygenate the patient with 100% oxygen for 30–60 seconds to prevent hypoxia.
3. Inserting the Suction Catheter:
   • Don sterile gloves.
   • Gently insert the suction catheter into the endotracheal or tracheostomy tube without applying suction.
   • Advance the catheter until resistance is felt (just before reaching the carina or the end of the tube).
4. Applying Suction:
   • Withdraw the catheter while applying intermittent suction, rotating it as you pull out.
   • Limit suctioning to 10–15 seconds to prevent oxygen desaturation.
5. Post-Suctioning:
   • Re-oxygenate the patient with 100% oxygen for 30–60 seconds between suctioning passes.
   • Repeat the procedure if necessary, allowing adequate time for the patient to recover between attempts.
6. Post-Procedure Care:
   • Clear the suction catheter with saline and discard it after use.
   • Monitor the patient’s respiratory status, oxygen saturation, and heart rate.

Nursing Considerations:

• Limit the frequency of suctioning to avoid trauma and hypoxia.
• Monitor for complications like infection, bleeding, or bronchospasm.
• Ensure equipment is functioning properly before and during the procedure.

These airway management procedures are critical in maintaining an open and functional airway in patients who cannot do so independently, ensuring proper ventilation and oxygenation. Proper training, sterile techniques, and monitoring are essential to prevent complications.