Oxygen Delivery and Airway Management for Nurses

Oxygen Safety

Because oxygen supports combustion, fire safety is a paramount nursing responsibility.

1. Prohibit Smoking: Ensure no smoking occurs near oxygen equipment.
2. Heat Sources: Maintain oxygen equipment at least $5\text{--}10$ feet away from heat sources.
3. Materials: Use only water-soluble products and ensure clothing and bedding are made of cotton.
4. Emergency Response: In the event of a fire, follow the RACE acronym (Rescue, Alarm, Contain, Extinguish) and use a fire extinguisher following the PASS technique (Pull, Aim, Squeeze, Sweep).

Artificial Airways and Airway Management

When a patient cannot maintain a patent airway spontaneously, artificial airways are utilized to ensure ventilation.

Endotracheal Tubes (ETT)

The ETT is used for short-term airway management and is inserted through the mouth, past the pharynx, and into the trachea.

• Care: Nurses must provide oral and nasal care every $2\text{--}4$ hours.
• Positioning: To prevent oral complications, the tube should be moved to the opposite side of the mouth every $8$ hours.
• Cuff Pressure: It is critical to monitor cuff pressure; excessive pressure can lead to tracheal tissue necrosis.
• Communication: Since intubated patients cannot speak, nurses must establish alternative communication methods and ensure the call bell is within reach.

Tracheostomy Tubes

Tracheostomies are used for long-term airway management, either with or without a ventilator.

Tracheostomy Components:

• Outer Cannula: The main body of the tube that stays in the stoma.
• Inner Cannula: This component must be cleaned periodically or replaced.
• Obturator: A guide used during insertion; it must be kept at the bedside at all times.

Tracheostomy Care and Suctioning: Tracheostomy care requires a sterile field. When replacing tracheostomy ties, always secure the new ties before cutting the old ones to prevent accidental decannulation.

Suctioning is often necessary to clear secretions. For adults, suction pressure should not exceed $150$ mmHg.

Nursing Tip: Always hyperoxygenate the patient before and after suctioning. Suctioning should be performed intermittently for no more than $10\text{--}15$ seconds per pass, and no more than two passes should be made before allowing the patient to recover.

Chest Tube Management

Chest tubes are utilized to restore negative pressure within the pleural space and to drain air or fluid.

Nursing Care for Chest Tubes:

• Positioning: The collection device must always remain below the level of the patient's chest to ensure proper drainage.
• Monitoring: Nurses must assess for tidaling (the rise and fall of fluid with respiration), air leaks, and subcutaneous emphysema (air under the skin).
• Emergency Supplies: Always keep a sterile dressing, hemostats with rubber tips, and respiratory equipment at the bedside.
• Clamping: Do not clamp a chest tube unless specifically assessing for an air leak or changing the drainage system.

Ventilation Categories

Ventilation can be categorized into two main types:

1. Noninvasive Ventilation: Includes devices like CPAP and BiPAP, which provide pressure to keep airways open without an artificial airway.
2. Invasive Ventilation: Involves positive pressure ventilation, typically requiring an artificial airway like an ETT or tracheostomy.