Oral Airway Insertion

Definition

Oral airway insertion is a technique used for keeping the airway open in an unconscious person. It is also called placing an oropharyngeal airway.

Purpose

Oral airway insertion is a technique for facilitating breathing in unconscious individuals. It is used when the airway is obstructed by or likely to become obstructed by the tongue. Not only does the oral airway device, also called an oropharyngeal airway, An oral airway is often inserted before bag and mask ventilation to keep the airway open. designed for free air flow. The airway is inserted as a means for airway protection (from relaxation of the tongue ) in an unconscious patient. The airway has a hollow opening through the center of it, which allows the passage of a suction catheter if suctioning of the patient is needed. Oral airway insertion is often an emergency procedure done in the field as part of the A B Cs (airways, breathing, circulation) of first aid response to injury or accident.

Precautions

Oral airway insertion is only used on people who are unconscious. In conscious individuals, insertion of the airway device may cause reflex gagging, vomiting, and aspiration of the stomach contents into the lungs. When the individual is suspected of having a neck or upper spine injury, care must be taken when moving the jaw to clear the airway so as not to aggravate any spinal injury.

Description

The oral airway is a J-shaped tube of hard plastic with a flange on the long arm of the J to keep the individual from swallowing the tube. The body, or curve of the J is shaped to conform to the shape of the roof of the mouth. The short side of the J is the tip. Oral airways come in different sizes. To select the correct size, the flange is placed at the corner of the mouth parallel to the front teeth. The tip of the J tube should reach no farther than the angle of the jaw.

To insert the oral airway, the unconscious patient is placed on his back. The mouth is cleared of debris and when possible suctioned to remove fluids. The jaw is pulled up and forward to help open the airway. Alternately, if spinal injury is suspected, the chin is lifted gently. The patient's mouth is opened as widely as possible. The oral airway is inserted with the tip of the J pointing toward the roof of the mouth. The tube is pushed about half way into the mouth and then rotated 180 degrees so that the tip of the J is now facing downward toward the windpipe (trachea). The tube should not be taped in place. The device needs to be checked regularly to make sure it remains positioned properly. The airway is removed by pulling it gently outward and down-ward. If used for a long time, the tube may need to be removed and cleaned, the mouth and lips need to be treated for irritation, and then the airway is one again replaced inserted.

Preparation

The patient is unconscious; no patient preparation is necessary. Often oral airway insertion is an emergency procedure.

Aftercare

As soon as the individual starts to return to consciousness, the oral airway will stimulate a gag reflex and possible vomiting. The device should be removed at the first signs of consciousness, since vomiting may cause the stomach contents to be aspirated (breathed into the lungs). Suction equipment should always be available.

Complications

If the J tube oral airway is too short, it will not hold the tongue out of the way. If the J tube oral airway is too long, it will unintentionally press the tongue back into the airway. In either case, the airway will not stay open. Other complications are usually related to failure to remove the tube as soon as the patient begins to regain consciousness.

Results

Oral airway insertion provides safe emergency intervention when the airway is blocked or in danger of becoming blocked. It may be used while preparing for artificial ventilation or endotracheal intubation.

Health care team roles

Oral airways can be inserted without a physician's order by almost anyone with advanced first aid training, including emergency medical technicians (EMTs), paramedics, military medics, and nurses. Physicians and dentists occasionally use oral airways in conjunction with various apparatus while performing other procedures. The person who inserts the oral airway may continue to care for the individual or may pass this responsibility onto another health care professional with additional training. Continuity of care depends on the circumstances surrounding the insertion.

KEY TERMS

Endotracheal intubation— Inserting a tube through the mouth into the trachea (windpipe) to keep the airway open.

Resources

OTHER

"Airway Control and Maintenance." Medinida.com. 23 November 2005. 〈http://www.medindia.net/education/lessons/2.asp〉 (November 23, 2005).

"Airway Establishment and Control." Merck Manual of Diagnosis and Therapy, Section 6 Chapter 65, 1995–2005. 〈http://www.merck.com/mrkshared/mmanual/section6/chapter65/65m.jsp〉 (November 23, 2005).

Dulak, Sally B. "Placing an Oropharyngeal Airway." RN. February 1, 2005. 〈http://mediwire.skyscape.com/main/〉 (November 27, 2005).

Health Sciences Media Division, US Army Medical Department C, Fort Sam Houston, Texas. Insert an Oral Airway. 〈http://www.brooksidepress.org/Products/OperationalMedicine/DATA/operationalmed/Procedures/OralAirway.htm〉 (November 23, 2005).