Some persons need artificial airways, suctioning, mechanical ventilation, and chest tubes. Needing respiratory rehabilitation, often they are very ill. They need to recover from problems affecting the airway and lungs. They need complex procedures and equipment.

The nurse may ask you to assist in their care. The center must teach and train you to provide needed care. The goals of care are to help the person:

• Reach his or her highest level of function

• Live as independently as possible

• Return home

Artificial airways

Artificial airways keep the airway patent (open and unblocked). They are needed:

• When disease, injury, secretions, or aspiration obstructs the airway

• For mechanical ventilation (p. 461)

• By some persons who are semi-conscious or unconscious

Intubation means inserting an artificial airway. Such airways are usually plastic and disposable. They come in various sizes. These airways are common:

• Oropharyngeal airway—inserted through the mouth and into the pharynx (Fig. 29-1, A). A nurse or respiratory therapist inserts the airway.

• Endotracheal (ET) tube—inserted through the mouth or nose and into the trachea (Fig. 29-1, B). A doctor inserts it using a lighted scope. Some RNs and respiratory therapists are trained to insert ET tubes. A cuff is inflated to keep the airway in place.

• Tracheostomy tube—inserted through a surgically created opening (stomy) into the trachea (tracheo) (Fig. 29-1, C). Cuffed tubes are common. The cuff is inflated to keep the tube in place. Doctors perform tracheostomies.

Fig. 29-1 Artificial airways. A, Oropharyngeal airway. B, Endotracheal tube. C, Tracheostomy tube.

Vital signs are checked often. Observe for hypoxia and other signs and symptoms. If an airway comes out or is dislodged, tell the nurse at once. Frequent oral hygiene is needed. Follow the care plan.

Gagging and choking feelings are common. Imagine something in your mouth, nose, or throat. Comfort and reassure the person. Remind the person that the airway helps breathing. Use touch to show you care.

Persons with ET tubes cannot speak. Some tracheostomy tubes allow speech. Paper and pencils, Magic Slates, and communication boards are ways to communicate. Hand signals, nodding the head, and hand squeezes are common for simple “yes” and “no” questions. Follow the care plan. Always keep the signal light within reach.

Tracheostomies

A tracheostomy is a surgically created opening (stomy) into the trachea (tracheo). Tracheostomies are temporary or permanent for mechanical ventilation (p. 461). They are permanent when airway structures are surgically removed. Cancer, severe airway trauma, or brain damage may require a permanent tracheostomy.

A tracheostomy tube is made of plastic, silicone, or metal. It has three parts (Fig. 29-2):

• The obturator has a round end. It is used to guide the insertion of the outer cannula (tube). Then it is removed. The obturator is placed within easy reach in case the tracheostomy tube falls out and needs re-insertion. It is taped to the wall or bedside stand.

• The inner cannula is inserted and locked in place. It fits inside the outer cannula. It is removed for cleaning and mucus removal. This keeps the airway patent. Some inner cannulas are disposable. Other tracheostomy tubes do not have inner cannulas.

• The outer cannula is secured in place with ties around the neck or a Velcro collar. The outer cannula is not removed. It keeps the tracheostomy patent.

The cuffed tracheostomy tube provides a seal between the cannula and the trachea (see Fig. 29-1, C). This prevents air from leaking around the tube. It also prevents aspiration. A nurse or respiratory therapist inflates and deflates the cuff.

The tube must not come out (extubation). If not secure, it could come out with coughing or if pulled on. A loose tube moves up and down. It can damage the trachea. Call the nurse if the outer cannula comes out.

The tube must remain patent. If able, the person coughs up secretions. Otherwise suctioning is needed. Call for the nurse if you note signs and symptoms of hypoxia or respiratory distress.