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Inserting an Oral or Nasal Airway

Purpose: To facilitate easy removal of secretions. To hold tongue forward and maintain open airway. To prevent biting of endotracheal or nasogastric tubes.

Special Considerations
• The airway should be removed by gently pulling downward and outward following the normal curve of the nose/mouth.
• This should be done at least every 4 hours.
• Good nasal and mouth care should be administered before reinsertion.
•Water-soluble lubricant should be applied to the lips to prevent cracking and breakdown from the pressure of the airway.
• After lips and mouth are cleaned, reinsert the oral airway.
• Before discontinuing the airway, ensure that the patient can follow commands and can swallow, and has regained gag and cough reflexes to prevent aspiration of airway secretions into the lungs.
• If nasal airway cannot be inserted, consider the following:
• Changing size of the tube.
• Relubricating airway and attempt to reinsert.
• Hyperextending the patient’s neck.
• Inserting the tube at a different angle.
• Inserting the oropharyngeal rather than nasopharyngeal airway.
• Patients with nasal airways need to be assessed for suctioning, especially the elderly and children.
• Keep materials for cleaning the nares and moisturizing the nasal mucosa close to the patient’s bedside.
• Assess the patient’s nares and face around the nasal tube for skin breakdown, especially in elderly patients.
• Prior to removal, suction airway to remove secretions.
• Rotate the airway to the other naris every 8 hours to prevent breakdown of nasal mucosa.

Relevant Nursing Diagnosis
Potential impaired gas exchange related to retained respiratory secretions

Expected Outcomes
● Airway placed atraumatically without damage to the nasal or oral airway or mucous membranes
● Airway properly secured
● Airway protected from obstruction

1. Explain procedure to patient/family.
Rationale: Decreases anxiety and facilitates cooperation.

2. Wash hands.
Rationale: Reduces transmission of microorganisms.

3. Gather equipment to the bedside, including an oral or nasal airway.
Rationale: Enhances efficiency and patient safety.

4. Prepare and test suction system.
Rationale: To ensure prompt removal of secretions that increase risk for aspiration.

5. Don nonsterile gloves.
Rationale: Reduces transmission of microorganisms.

6. Rinse airway with cool water.
Rationale: Facilitates insertion; acts as a lubricant.

7. Position patient in semi-Fowler’s or Fowler’s position; place a pillow or shoulder roll under the shoulders to hyperextend the neck.
Rationale: The semi-Fowler’s/Fowler’s position can facilitate removal of secretions, should patient vomit. Hyperextension of the neck opens the airway and helps keep the tongue from the pharynx.

8. Determine if the patient needs an oral or a nasopharyngeal airway.
Rationale: An oral airway should only be placed on an unconscious or unresponsive patient or when nares are occluded.

Nasal Airway
1. Select the naris that looks most patent by examining each side of the nares with a flashlight to observe for occlusion.
Rationale: To facilitate easy insertion of nasal tube without trauma to the patient with multiple attempts of insertion.

2. Select appropriate size nasal airway (should extend from tip of nares to earlobe). For optimal fit, the lumen of airway should be narrower than patient’s nares airway.
Rationale: Choosing correct airway size will ensure adequate patency and facilitate easy removal of secretions.

3. Wash hands, and don nonsterile gloves.
Rationale: Reduces transmission of microorganisms which could cause infection.

4. Lubricate entire length of tube with water-soluble jelly or anesthetic jelly. Check with patient’s physician to determine if anesthetic lubricant can be used.
Rationale: To prevent trauma to the airway and facilitate insertion.

5. Insert the entire tube gently through the naris. Follow the anatomic line of the nasal passage.
Rationale: If you feel resistance, the naris may be deviated or obstructed. Attempt placement via the other naris.

6. Validate proper positioning by:
● Feeling exhaled air with your hand through tube opening.
● Inspecting, with patient’s mouth open, for the tip of tube behind uvula.
Rationale: To ensure that the nasal tube is in the correct position and promoting respiratory function.

7. Suction mouth and throat if needed.
Rationale: Removes accumulated or loosened secretions pooled in mouth and throat.

8. Discard dirty gloves.
Rationale: Reduces transmission of infection.

9. Wash hands.
Rationale: To prevent the spread of microorganisms.

Oral Airway
1. Choose the correct size oral airway based on patient’s age, size, and condition.
Rationale: To ensure adequate airway patency and ease of removal of secretions.

2. Hold oral airway with the curved end up.
Rationale: Makes insertion of airway easier.

3. Slide oral airway in until tip is at the lower half of tongue.
Rationale: Ensure accurate placement.

4. Tape airway securely to prevent injury to lips, teeth, tongue, and posterior pharynx.
Rationale: Prevents expulsion of nasal airway.

5. Suction mouth and throat if needed.
Rationale: Removes accumulated or loosened secretions pooled in mouth and throat.

6. Discard dirty gloves.
Rationale: Reduces transmission of infection.

7. Wash hands.
Rationale: Prevents the spread of microorganisms.

Evaluation and follow up activities
● Assess patient’s respiratory status, and compare to pre-insertion respiratory status
● If patient is attempting to remove or push airway out, consider that the airway may no longer be needed
● Assess for trauma to lips, teeth, tongue, and pharynx
● If the patient is gagging, consider a smaller airway
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