Chapter 53: Airway management

Oxygen therapy

Oxygen therapy

The administration of oxygen to maintain an SpO2 of 95% to 100% using the lowest effective oxygen flow rate to prevent complications.

Fraction of inspired oxygen (FiO2)

The percentage of oxygen a client receives during oxygen therapy.

Pulse oximetry

Noninvasive measurement of blood oxygen saturation to monitor respiratory status based on assessment findings like increased work of breathing, cyanosis, or changes in respiratory rate.

Hypoxemia

A condition indicated by pulse oximetry readings below 90%, requiring interventions like confirming probe placement, ensuring proper oxygen delivery, and positioning the client for optimal ventilation.

Reference range

The expected SpO2 range is 95% to 100%, with acceptable levels from 91% to 100%, and readings below 90% indicating hypoxemia.

Factors affecting readings

Conditions like hypothermia, poor blood flow, excessive light exposure, low hemoglobin levels, jaundice, movement, edema, and nail polish can lead to inaccurate pulse oximetry readings.

Pulse Oximetry

Noninvasive measurement of blood oxygen saturation used to monitor respiratory status by assessing indicators like work of breathing, cyanosis, and changes in respiratory rate.

Oxygen Therapy

Administration of oxygen to treat hypoxemia, requiring a prescription and careful monitoring of respiratory status and oxygen saturation levels.

Fraction of Inspired Oxygen (FiO2)

The percentage of oxygen a client receives, crucial in adjusting oxygen flow rates to maintain optimal oxygen saturation levels.

Hypoxemia

Low levels of arterial oxygen, indicated by symptoms like tachypnea, tachycardia, cyanosis, and confusion, necessitating oxygen therapy.

Pulse Saturation (SpO2)

Measurement of oxygen saturation in the blood using a pulse oximeter, reflecting the percentage of hemoglobin saturation when above 70%.

Hypoxia Manifestations

Early signs include tachypnea, restlessness, and pale skin, while late signs encompass bradypnea, stupor, and cyanotic skin, indicating severe oxygen deprivation.

Nursing Actions for Oxygen Therapy

Include monitoring respiratory status, ensuring proper mask fit, assessing oxygenation with pulse oximetry and ABGs, promoting oral hygiene, and adjusting oxygen flow rates to maintain optimal saturation levels.

Face Tent

A low-flow oxygen delivery system that covers the client's face without directly contacting the nose or mouth.

Nasal Cannula

Oxygen delivery system with tubing and prongs inserted into the nares, providing FiO2 of 24% to 44% at 1 to 6 L/min.

Fraction of Inspired Oxygen (FiO2)

The percentage of oxygen in the air delivered to the client, ranging from 24% to 60% in different delivery systems.

Advantages of Nasal Cannula

Safe, simple, comfortable, allows eating/talking/ambulation, but FiO2 varies with flow rate and can cause skin breakdown.

Simple Face Mask

Covers nose and mouth, delivering FiO2 of 35% to 60% at 5 to 10 L/min flow rates, but can lead to CO2 rebreathing and skin breakdown.

Nursing Actions for Nasal Cannula

Assess nares patency, ensure proper prong fit, use water-soluble gel, provide humidification for higher flow rates.

Nursing Actions for Face Mask

Assess proper fit, monitor for skin breakdown, use caution for aspiration risk, ensure client wears nasal cannula during meals.

Non-rebreather Mask

Covers the client’s nose and mouth, delivering an FiO2 of 80% to 95% at flow rates of 10 to 15 L/min, with a reservoir bag kept ⅔ full.

Venturi Mask

Covers the client’s nose and mouth, delivering an FiO2 of 24% to 60% at flow rates of 4 to 15 L/min via different size adapters for precise oxygen concentration.

Aerosol Mask

Includes face tent and tracheostomy collar, delivering an FiO2 of 24% to 100% at flow rates of at least 10 L/min with high humidification.

Non-rebreather Mask Advantages

Delivers high O2 concentration, has a one-way valve for maximum O2 inhalation, and prevents room air entry.

Venturi Mask Advantages

Provides precise oxygen concentration with added humidity, suitable for chronic lung disease clients.

Aerosol Mask Advantages

Useful for clients intolerant to masks, with facial trauma, burns, or thick secretions.

Non-rebreather Mask Disadvantages

Requires intact valve and flap, poorly tolerated by anxious clients, impairs eating, drinking, and talking.

Venturi Mask Disadvantages

Expensive, impairs eating, drinking, and talking, may cause skin breakdown.

Aerosol Mask Disadvantages

High humidification needs frequent monitoring, may lead to skin breakdown, requires tubing care and condensation management.

Nursing Actions for Non-rebreather Mask

Hourly valve and flap assessment, proper fit check, and nasal cannula use during meals.

Nursing Actions for Venturi Mask

Frequent flow rate assessment, proper fit check, tubing without kinks, and nasal cannula use during meals.

Nursing Actions for Aerosol Mask

Regular condensation emptying, humidification canister water check, aerosol mist venting confirmation, and tracheostomy care.

Oxygen Toxicity

Results from high oxygen concentrations (>50%), prolonged oxygen therapy (>24-48 hr), and lung disease severity. Manifestations include cough, substernal pain, nausea, dyspnea, and paresthesias.

Oxygen-induced Hypoventilation

Sensitivity to oxygen in clients with alveolar hypoventilation. Monitor respiratory rate, consciousness, SpO2, and use low oxygen flow rates.

Combustion

Oxygen is combustible. Nursing actions include posting warning signs, knowing fire extinguisher locations, educating about fire hazards, using cotton gowns, and ensuring grounded electric devices.

Airway Clearance

Techniques to mobilize secretions and maintain airway patency. Includes coughing, hydration, positioning, nebulizer therapy, chest physiotherapy, and suctioning.

Sputum Specimen Collection

Collection for cytology, culture, AFB testing. Considerations include timing, aseptic technique, specimen containers, and methods for specimen collection.

Chest Physiotherapy

Techniques to loosen respiratory secretions and move them for removal. Includes percussion, vibration, postural drainage. Contraindicated in certain conditions.

Don the required personal protective equipment

Ensure proper protection before the procedure.

Assist the client to high-Fowler’s or Fowler’s position for suctioning if possible

Position the client appropriately for the procedure.

Encourage the client to breathe deeply and cough in an attempt to clear the secretions without artificial suction

Promote natural secretion clearance efforts.

Remove the bag or ventilator from the tracheostomy or endotracheal tube and insert the catheter into the lumen of the airway

Properly insert the suction catheter for endotracheal suctioning.

Pull the catheter back 1 cm (0.4 in) prior to applying suction

Ensure proper positioning before suctioning.

Reattach the BVM or ventilator and administer 100% oxygen

Provide oxygenation after suctioning.

Rinse catheter and suction tubing with sterile saline until clear

Clean the equipment post-suctioning.

Single-lumen (Cannula)

A long, single-cannula tube suitable for clients with long or thick necks, not recommended for clients with excessive secretions.

Double-lumen (Cannula)

Consists of an outer and inner cannula with an obturator for insertion, allows for cleaning and replacement of the inner cannula, suitable for clients with excessive secretions.

Cuffed Tube

Features a balloon that inflates to protect the lower airway, permits mechanical ventilation, prevents aspiration, requires monitoring of cuff pressures.

Cuffless Tube

Does not have a balloon, used for long-term airway management, allows the client to speak, not for clients on mechanical ventilation.

Fenestrated Tube with a Cuff

Contains openings in the outer cannula with a balloon, allows for mechanical ventilation, speaking, and airflow through the fenestrations.

Fenestrated Tube without a Cuff

Features openings in the outer cannula without a balloon, aids in weaning from the tracheostomy, allows speaking and airflow through the fenestrations.

Considerations

Include keeping extra tubes, oxygen source, communication methods, humidification, oral care, tracheostomy care, suctioning, and repositioning for client care.