The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [389]
Figure 10.38 Insert the Guedel airway in an upside down position to the junction of the hard and soft palate. Used with permission from Moule and Albarran (2009).
Figure 10.39 Rotate the Guedel airway 180° once you have reached the junction of the hard and soft palate. Used with permission from Moule and Albarran (2009).
Figure 10.40 Insert the Guedel airway until it lies in the oropharynx. Used with permission from Moule and Albarran (2009).
Use of the incorrect size oropharyngeal airway may result in trauma, laryngospasm and/or worsening of the airway obstruction.
Suction equipment such as a wide-bore suction end (Yankauer sucker – Figure 10.41) should be used to remove liquid (blood, saliva and gastric contents) from the upper airway. This is done best under direct vision during intubation but should not result in any delay in achieving a definitive airway. If tracheal suction is necessary, it should be as brief as possible and preceded and followed by ventilation with 100% oxygen.
Figure 10.41 Yankauer sucker.
Endotracheal suction catheters (Figure 10.42) are used to clear secretions from endotracheal or tracheostomy tubes or laryngeal airway masks (Hallstrom et al. 2000, Resuscitation Council 2010b).
Figure 10.42 Endotracheal/tracheostomy suction catheter.
A laryngeal mask airway (LMA) (size 4) or Combitube (small) consists of a wide-bore tube with an elliptical inflated cuff designed to seal around the laryngeal opening. It is easier to ventilate a patient using bag-valve-LMA ventilation than using bag-valve-facemask ventilation, because of difficulty of ensuring no air leak on the facemask, especially if there is only one person available to ventilate the patient. The LMA is a reliable and safe device and has a high success rate, after a short period of training (Figure 10.43) (Hallstrom et al. 2000, Resuscitation Council 2010b).
Figure 10.43 Laryngeal mask airway.
A McGill forceps (Figure 10.44) is a curved forceps which can be used by the anaesthetist for a difficult intubation and to help introduce an endotracheal tube during intubation (Figure 10.45). Tracheal intubation is considered to be superior to other advanced techniques of airway management because the airway is reliably isolated from foreign material in the oropharynx (Hallstrom et al. 2000). Extensive training and regular practice are required to acquire and maintain the skills of intubation, and endotracheal tubes (oral, cuffed, sizes 6, 7 and 8) are kept on emergency trolleys and should be sized according to the patient’s size and gender.
Figure 10.44 McGill forceps.
Figure 10.45 Endotracheal tubes.
An introducer such as a gum elastic bougie (Figure 10.46) or a semi-rigid stylet is a useful aid to intubation. Water-soluble lubricating jelly is used prior to intubation or insertion of the LMA or nasopharyngeal airway to aid smooth insertion.
Figure 10.46 Bougie.
A laryngoscope (Figure 10.47) with both curved Macintosh and long blades is used by the anaesthetist to visualize the vocal cords prior to intubation. It consists of a handle with either rechargeable or removable batteries and a light source, which needs to be checked regularly, as well as just before use, and in case of malfunction spare batteries and light sources need to be available (Resuscitation Council 2010b).
Figure 10.47 Laryngoscope handle and blade.
Assessment and recording tools
Decisions relating to CPR ideally should have been documented prior to a cardiac arrest. Every hospital should have a DNAR policy based on national guidelines (BMA et al. 2002, Jevon 2001).
During and after a cardiac arrest, all resuscitation attempts should be documented for auditing purposes, ideally using a nationally recognized template such as the Utstein template (recommended for use by the RCUK). If these recommendations are implemented, standards in resuscitation and resuscitation training