Topic 1: SUCTIONING ENDOTRACHEAL TUBE (ETT) Objectives:
o Remove accumulated secretions
Anatomy of the Airway o Maintain clear airway
Upper Airway: o Improve ventilation and oxygenation
o Nose & nasal cavity - filters, warms, moistens o Prevent pneumonia and atelectasis
air
o Pharynx (nasopharynx, oropharynx, Indications & Assessment:
laryngopharynx) - o Visible secretions or gurgling sounds
air passage o Decreased SpOr
o Larynx - contains vocal cords; protects airway o Increased respiratory effort
during swallowing o Abnormal breath sounds (rhonchi/crackles)
Lower Airway: Ventilator alarms (high pressure)
o Trachea - rigid tube with C-shaped cartilage
rings Procedures:
o Bronchi → bronchioles → alveoli (site of gas o Perform hand hygiene and don PPE
exchange) o Pre-oxygenate with 100% O2 (30-60 sec)
o Insert sterile catheter without suction
o Apply suction (80-120 mmHg adults) while
withdrawing
o Limit suctioning to 10-15 seconds
o Re-oxygenate and allow rest between passes
Nursing Considerations:
o Monitor HR, RR, SpOz
o Avoid mucosal trauma
o Maintain sterility
o Watch for complications: hypoxia, arrhythmia
o Document findings and patient response
Endotracheal Tube (ETT) Anatomy
o Flexible tube inserted into the trachea via
mouth/nose
o Cuff - inflated balloon that seals airway and
prevents aspiration Topic 2: VENTILATING THE CLIENT WITH AN
AMBUBAG
o Connector - attaches to ventilator or Ambu
bag
Learning Objectives
o Murphy eye-side opening for airflow if tip is
➢ By the end of this lesson, students will be able to:
blocked
1. Describe the purpose and indications for Ambu
o Function: ensures airway patency and controlled
ventilation bag ventilation.
2. Identify the equipment needed.
3. Demonstrate proper technique for bag-valve-
mask ventilation.
4. Apply safety measures during the procedure.
BVM SIZES (Bag-Valve Mask) TECHNIQUE:
o One-person technique: use the E-C clamp
1. INFANT - patients weighing up to technique the index finger and thumb in an "C"
10kg shape on the top of the mask, and the
2. PEDIATRIC- patients weighing remaining fingers in a "E
10kg-40kgs "shape under the jaw, lifting the chin to maintain
an open airway.
3. ADULT - patients weighing 40kg
o Sniffing position if C-spine OK
above o Adult: aim for for breaths per minute, or one
breath every 5-6 seconds
Definition & Purpose
o Pedia: aim for 12-20 breaths per minute one
o Ambu Bag (Bag-Valve-Mask): A manual
breath every 3-5 seconds
resuscitator used to provide positive pressure
o Two -person technique: one person secures the
ventilation to patients who are not breathing or
mask using the thenar eminences (muscular
breathing inadequately.
part of the hand at the base of the thumb) while
o Purpose:
the other person squeezes the bag
o Maintain oxygenation and ventilation.
o Prevent hypoxia.
Complication
o Bridge to advanced airway
o Aspiration
management.
o Hypoventilation
➢ (American Heart Association [AHA], 2020)
o Hyperventilation
o Pneumothorax-hyperventilation with ambubag
Indications
may lead to barotrauma causing lethal
o Respiratory arrest.
complication of pneumothorax (4-15%)
o Severe respiratory distress.
o Hypoventilation.
Contradictions
o During cardiopulmonary resuscitation (CPR).
o BVM ventilation is not possible in case of
o As a temporary measure before intubation."
complete unseen airway obstruction
o BVM ventilation is relatively contraindication
Equipment Needed
after paralysis or induction ( aspiration)
o Bag-valve-mask device.
o Caution id advised in patients with severe facial
o Appropriate-size mask.
trauma and eye injuries
o Oxygen source (10-15 L/min).
o In addition, foreign materials like gastric
o Oxygen reservoir (if available).
contents in the airway may lead to aspiration
o Airway adjuncts (oropharyngeal
pneumonitis, including endotracheal
airway/nasopharyngeal airway).
intubation,may be necessary
o Suction device.
o Gloves.
Monitoring & Troubleshooting
➢ (Bickley, 2021; WHO, 2009)
o Observe chest rise and breath sounds.
o Check skin color and Sp02.
Preparation Steps:
o If ineffective:
1. Verify order or emergency need.
o Reposition mask.
2. Perform hand hygiene.
o Re-open airway.
3. Gather equipment.
o Suction if needed.
4. Check Ambu bag function.
➢ (Perkins et al., 2021)
5. Connect to oxygen source.
6. Identify patient using two identifiers.
Post-Procedure Care
➢ (The Joint Commission, 2024; WHO, 2009)
1. Reassess patient.
2. Continue ventilation until spontaneous
Positioning & Airway Preparation
breathing or advanced airway.
o Supine position on firm surface.
3. Dispose/decontaminate equipment.
o Head-tilt/chinlift or jaw-thrust (if spinal injury
4. Perform hand hygiene.
suspected),
5. Document procedure and patient response.
o Insert OPA/NPA if indicated.
➢ (CDC, 2024; WHO, 2009)
o Sniffing position
o Select correct mask size.
Safety Considerations
➢ (AHA, 2020; Bickley, 2021)
o Avoid excessive ventilation pressure.
o Monitor for gastric inflation.
o Ensure adequate oxygen flow.
o Maintain airway patency.
o Seek advanced away support if needed.
➢ (AHA, 2020; Perkins et al., 2021)
Topic 3: TRACHEOSTOMY CARE AND Nursing Considerations:
MAINTENANCE o Assess for redness, swelling, discharge
o Prevent accidental decannulation
Objectives: o Keep emergency equipment nearby
o Maintain airway patency o Maintain humidification
o Prevent infection o Document care
o Promote healing of stoma
o Ensure adequate ventilation
Indications: Topic 4: ASSISTING IN ENDOTRACHEAL TUBE
o Airway obstruction INTUBATION
o Long-term ventilation
o Neuromuscular conditions Definition:
o Secretion management ➢ Endotracheal Tube Intubation
- is a measure that provides complete
Anatomy: control over the airway. Commonly
o Trachea called intubation.
o Extends from larynx to bronchi - An Endotracheal Tube is passed
o Supported by cartilage rings through the mouth or less commonly
o Stoma the nose, into the patients lungs
o Surgical opening in anterior neck ➢ For adults, typical sizes range from 7.0 to 8.5 mm
o Direct access to airway ID, with women often needing 7.0-7.5 and men
needing 7.5-8.5. Pediatric ETT sizes are
determined by age and often estimated using
formulas, such as [(Age/4) + 4] for uncuffed tubes.
Learning Objectives:
o Identify the steps in preparing for ETT insertion
o Demonstrate assistance during the procedure
o Apply post-procedure monitoring and care
Tracheostomy Tube Parts
o Outer cannula - remains in place
o Inner cannula - removable for cleaning
o Obturator - used during insertion
o Flange/neck plate - secures tube
o Ties - hold tube in place
Procedure:
o Perform hand hygiene and wear sterile gloves
o Remove inner cannula and soak in saline or
solution
o Clean stoma from inner → outer using sterile
technique
o Dry area and apply sterile dressing
o Replace inner cannula securely
o Change ties (one side at a time)
o Set up and check equipment for intubation.
Place it in a convient location on a sterile towel
or drape, close to the patient's head.
o Check the light on the laryngoscope blade.
Snap the blade onto the handle and then fold it
up and down. When pulled up, the light should
go on. Folding it down tums the light off.
o Set up suction apparatus and connect rigid
suction tip catheter to tubing.
o Apply gloves
o Check the mouth for dentures and remove if
present. Suction mouth and pharynx as
needed.
o Assist the physician as directed as he or she
performs the intubation procedure.
Rationale You may be asked to ventilate the patient
o To provide a means of delivering 100% oxygen belore the procedure.
directly to the lungs o After the tube has been inserted,note and
o Provide a method for delivering positive record the centimeter mark on the tube where it
pressure ventilation in a code or other exists the mouth, Record the volume of air used
emergency in which the patient requires to inflate the cuff.
ventilation assistance. o After insertion,call xray for a portable x-ray for
o To protect the airway in patients who are at risk the tube placement.
for aspiration o Perform procedure completion actions.
o To maintain a patent airway in patients with Connect the endotracheal tube to oxygen
burns, inhalalion injuries, or ingestion of caustic source or mechanical ventilator.
substances that cause swelling in the throat or o Secure ET tube in place
lower airway. o Remove gloves. Wash hands.
o To provide a pathway through which the health
care professional can suction the lungs. Assisting During Procedure
o Preoxygenate patient (100% Or for 3-5
Equipment minutes)
o Mask, face shield or other personal protective o Hand correct ETT size to physician
equipment depending on the patients situation o Apply cricoid pressure if requested
and facility policy o Assist with suctioning
o Disposable examination gloves o Monitor vital signs and SpOr
o Sterile towel or drape
o Laryngoscope handle and blades Safety Considerations
o Stylet o Avoid contamination of equipment
o 10 ml syringe o Prepare for possible complications: hypoxia,
o Water soluble lubricant aspiration, misplaced tube
o Tape 1 and 2 inch sizes or endotracheal tube o Maintain communication with the team
holder
o Oral airway Evaluation
o Stethoscope o Record placement of the patient artificial airway
o Bag-valve-mask o Properly positioned and secured airway
o Humidified oxygen source o Improved oxygenation and ventilation
o Sterile gauze pad o Facilitation of secretion clearance.
o Sterile water
o Sterile Basin
o Kelly clamp or other hemostat
o Suction set up with flexible catheter
Preparation Phase
o Verify physician's order
o Gather necessary equipment
o Perform hand hygiene and wear PPE
o Check equipment functionality
o Explain procedure to patient /patient relatives
o Position patient appropriately
Implementation
o Wash hands, and don on PPE, including eye
protection.
o Attach patient to pulse oximeter and cardiac
monitor.