16.2 Airway Management and Suctioning

Airway management is crucial for patient safety and respiratory function. Nurses must assess airway patency, recognize signs of compromise, and implement appropriate interventions. From simple positioning to advanced techniques like intubation, the goal is to maintain a clear airway.

Suctioning is a key skill in airway management, removing secretions to improve breathing. Proper technique, including patient preparation and post-procedure care, is essential. Nurses must understand indications, contraindications, and potential complications to ensure safe and effective suctioning.

Airway Management Interventions

Assessment Techniques for Airway Management

• Evaluate patient's level of consciousness, respiratory rate, depth, and pattern
• Identify signs of airway compromise (stridor, wheezing, gurgling, cyanosis, use of accessory muscles, altered mental status)
• Utilize Glasgow Coma Scale (GCS) to assess patient's ability to protect their airway
• Employ pulse oximetry and arterial blood gas analysis for oxygenation and ventilation status
• Recognize risk factors for airway obstruction (trauma, burns, neuromuscular disorders)
• Base intervention decisions on clinical findings, diagnostic results, and overall patient condition

Intervention Strategies

• Implement simple positioning techniques for mild airway issues
• Progress to advanced procedures like endotracheal intubation for severe airway compromise
• Adjust interventions based on severity of airway compromise
• Consider non-invasive ventilation options (CPAP, BiPAP) for appropriate cases
• Prepare for rapid sequence intubation in emergency situations
• Collaborate with respiratory therapy and physicians for complex cases

Oral and Nasopharyngeal Suctioning Techniques

Preparation and Safety Measures

• Perform proper hand hygiene before initiating suctioning procedure
• Don appropriate personal protective equipment (PPE) (gloves, gown, face shield)
• Explain procedure to patient if conscious to reduce anxiety
• Assemble necessary equipment (suction catheter, collection container, sterile gloves)
• Position patient appropriately, typically with head of bed elevated 30-45 degrees
• Pre-oxygenate patient to prevent hypoxia during suctioning

Suctioning Procedure and Techniques

• Insert rigid suction catheter into mouth and pharynx for oral suctioning
• Use soft, flexible catheter inserted through nares for nasopharyngeal suctioning
• Apply appropriate suction pressure (80-120 mmHg for adults, lower for pediatric and geriatric patients)
• Limit suctioning duration to 10-15 seconds to prevent hypoxia
• Insert catheter to appropriate depth without suction, then withdraw while applying intermittent suction
• Rotate catheter between fingers during withdrawal to ensure thorough suctioning
• Rinse catheter with sterile saline between passes to maintain patency

Post-Suctioning Care

• Reassess patient's respiratory status (breath sounds, oxygen saturation, work of breathing)
• Provide oral care to reduce risk of oral infections
• Document procedure details (amount and characteristics of secretions, patient tolerance)
• Monitor for complications (mucosal trauma, bleeding, desaturation)
• Evaluate effectiveness of suctioning and need for repeat procedure
• Dispose of used equipment according to facility protocol

Airway Suctioning: Indications, Contraindications, and Complications

Indications and Assessment

• Identify audible or visible secretions in airway
• Recognize decreased oxygen saturation as potential indicator
• Assess for increased work of breathing (use of accessory muscles, tachypnea)
• Evaluate patient's ability to clear secretions independently
• Consider suctioning for patients with artificial airways (endotracheal tubes, tracheostomies)
• Assess effectiveness of patient's cough reflex

Contraindications and Precautions

• Avoid suctioning in patients with severe bleeding disorders (hemophilia, severe thrombocytopenia)
• Use caution in patients with facial trauma to prevent further injury
• Recognize epiglottitis as absolute contraindication due to risk of complete airway obstruction
• Exercise caution in patients with increased intracranial pressure
• Consider alternatives for patients with severe bronchospasm or status asthmaticus
• Evaluate risk-benefit ratio for patients with recent oral surgery or known tracheal stenosis

Potential Complications and Management

• Monitor for hypoxia during and after suctioning procedure
• Watch for cardiac arrhythmias, particularly bradycardia due to vagal stimulation
• Assess for mucosal trauma (bleeding, tissue damage) post-suctioning
• Be aware of potential for increased intracranial pressure in patients with head injuries
• Recognize signs of atelectasis or alveolar collapse from excessive negative pressure
• Implement strategies to minimize complications (pre-oxygenation, limiting suction duration, proper technique)

Nursing Role in Airway Management

Assisting with Endotracheal Intubation

• Prepare essential intubation equipment (laryngoscope, endotracheal tubes, stylet, bag-valve-mask, suction apparatus)
• Assist with patient positioning (sniffing position for most adults)
• Monitor vital signs during intubation procedure
• Confirm tube placement post-intubation (auscultation, end-tidal CO2 monitoring, chest x-ray)
• Secure endotracheal tube to prevent displacement
• Initiate mechanical ventilation if ordered, adjusting settings as directed

Tracheostomy Care and Management

• Maintain clean stoma site through regular cleaning and dressing changes
• Perform routine tracheostomy tube changes as per facility protocol
• Conduct tracheostomy suctioning using appropriate technique and catheter size
• Educate patient and family on tracheostomy care, especially for home transitions
• Monitor for complications (infection, tube displacement, tracheal damage)
• Ensure proper humidification of inspired air to prevent mucus plugging
• Collaborate with speech therapy for communication strategies and speaking valve use