Maintaining an open airway to promote oxygenation and ventilation is the cornerstone of airway management. A variety of different tools can be used in the process, ranging from basic to advanced, depending on the patient’s status and provider’s level of training.
For a small hospital nurse, having the proper supplies on hand is especially imperative. Small hospitals may not have physicians in-house around the clock, especially on nights and weekends, and nurses may have even more autonomy in airway management. So, what supplies need to be readily available? Let’s start with the most basic.
Clearing the airway should be the first priority since secretions, vomit and other foreign materials can obstruct the airway. Suction not only helps create a patent airway, but it decreases the likelihood of later complications from aspiration.
In-wall suction can be utilized if it is present. However, small hospitals may not have in-wall suction available at every bedside, so portable suction machines should be available. Portable suction can also be used in the case of utility failure, patient transport, evacuation, or for any emergencies that occur away from the bedside.
A bag valve mask allows a patient to be oxygenated and ventilated even without an advanced airway. Nurses must be familiar with choosing the proper size face mask, creating a good seal, and opening the airway in order to achieve effective ventilation.
Oral Airway (OPA)
For an unconscious patient with no gag reflex, an OPA can be inserted into the mouth. This can be used in conjunction with bag-mask ventilation and helps keep the tongue from blocking the airway.
Nasal Airway (NPA)
Serving a similar purpose to an OPA, a NPA can be placed into the nose of a conscious or unconscious patient. It should be avoided in patients who have sustained trauma to the head.
Devices that Provide Supplemental Oxygen, such as Nasal Cannula or Face Mask
Supplemental oxygen should be supplied to patients in distress. Nasal cannulas and face masks can be used to deliver low-flow oxygen. Face-masks with an oxygen reservoir and a Venturi mask can deliver higher concentrations of oxygen if needed.
The following supplies would be considered part of advanced airway management. Whether a nurse can use these tools herself depends on specialized training, facility policies, and the individual state’s Nurse Practice Act. In the case that a nurse cannot utilize these advanced tools, it is still important to understand when they are needed and have them available for the appropriate practitioner.
When a patient cannot breathe on their own, intubation with an endotracheal tube has long been the gold standard. It keeps a protected and patent airway, allows for high concentrations of oxygen to be delivered, and facilitates ventilation. A patient should only be intubated by a skilled provider since there are dangerous consequences that can occur as the result of improper intubation.
Supraglottic Airway Devices, such as Laryngeal Mask Airway (LMA) and Combitube
In situations where intubation is difficult or the provider does not have the necessary training, devices such as the LMA and Combitube are acceptable alternatives. While they still require training to use, they can be placed without visualizing the vocal cords and are generally simpler to insert than an ETT. They provide a secure airway and allow for proper ventilation. However, patients should be monitored for regurgitation and quickly suctioned if vomiting is noted.
Working in a small hospital presents its unique set of challenges, and nurses often have added responsibilities with regard to patient care. Having the proper airway management supplies available and knowing when to use them will facilitate the smooth management of respiratory emergencies.