Artifical Airways

Artifical Airways

Care of the Patient with an Artificial Airway. Care of the Patient with an Artificial Airway. An artificial airway is a tube inserted in the trachea either through the mouth or nose or by a surgical incision.

Endotracheal Tube -

  1.  Adult oral tube sizes: Males 8.0–8.5, I.D. (mm); females 7.0–8.0. I.D. (mm) (internal diameter).
  2.  Placement is 2 cm above the carina. Verify by auscultating for breath sounds bilaterally, uniform up-and-down chest movement, CXR, and checking end-tidal CO2 immediately after intubation.
  3.  Cuff pressure: 20–25 mm Hg.

Tracheostomy Tube -

  1.  Size will vary.
  2.  Cuff pressure: 20–25 mm Hg.

Minimal leak technique or minimal occluding volume verifies that an ETT or tracheostomy tube is at its lowest inflation point. Attach a 10-mL syringe to the balloon of the inflated cuff. Position your stethoscope on the patient’s neck at the area of the carotid pulse. Inflate balloon cuff to a point where no leak is heard. Slowly remove air from the inflated cuff until you hear a slight leak at the height of inspiration. Then add 1 mL of air back into the cuff.

Cuff pressure can also be monitored via a calibrated aneroid manometer device. Connect manometer to cuff. Deflate cuff. Reinflate cuff in 0.5 mL increments until desired cuff pressure is achieved. Check cuff pressure every 8–12 hrs or per agency protocol.