Tips to organize a box for alternative airways
When managing a difficult airway, seconds count. Having alternative airway supplies on hand can speed the process and calm frazzled nerves.
"This equipment is rarely used, but when you need it, you need it now," says Melody Schlaman, RN, BSN, nurse manager of the ED at Loma Linda (CA) University Medical Center. If you can’t intubate a patient and you’ve already sedated them, you need to have an immediate response.
Nurses at Loma Linda put together a portable box with alternative airway supplies to eliminate confusion at that moment of need.
"You can’t go digging through drawers to find what you need," Schlaman emphasizes. "We definitely wanted it to be portable," she says. "If we had used an alternative airway drawer, we would have been going back to the same system we had before."
Having the box on hand has given nurses a sense of preparedness under intense pressure.
"When a physician says, I need this kit now,’ most nurses feel a sense of panic because you want the patient to have that airway, and it’s your job to find that equipment," says Schlaman.
The box improves accessibility of supplies. Any staff member can get this equipment now, says Jeff Bender, RN, MICN, a nurse in the hospital’s ED who has used the box. "It doesn’t have to be someone who knows what attachments go with every piece of equipment," Bender says. "You don’t use this every day, and when you have a transient population of residents, it’s a whole lot easier to just say, We need the airway box.’"
Physicians benefit as well, since they don’t always have to rely on nurses to get the equipment. Doctors like it because they can take more initiative, Schlaman explains. "If they anticipate a need, they can pull this out and start digging through it, so it allows them more independence."
Here are the steps involved in creating the ED’s alternative airway box:
1. An oversized box was purchased from Healthcare Logistics, and its tray was removed.
"We wanted a large, open box with plenty of room because a lot of this equipment is large," says Schlaman.
2. Physicians were asked what equipment they wanted included in the box.
"We already knew what we had in our airway kits for a typical intubation, so we also pulled all those pieces of equipment together," Schlaman explains.
3. A decision was made to store the box on top of the Pyxis unit, which is in close proximity to the ED’s three critical care rooms.
"We wanted it in a central location," says Schlaman. The boxes are bright red, so having them sitting in the middle of the department keeps reminding people of the location.
4. A second alternative airway storage box was assembled and stacked on top of the original box.
"I don’t think we’ve ever used both of them at the same time, but because we’re a large trauma center, you just never know," notes Schlaman.
Nurses restock supplies after alternative airway procedures.
"That’s another benefit to having two boxes: If it’s really hectic one night and you just don’t have time, you have some leeway in knowing you can use the second one if you need to," Schlaman says. The nurse can just slap a patient label on the box, so the next nurse will know to restock and charge that patient.
5. A memo was sent to the ED staff listing the contents and location of the box.
Here is a list of supplies in the ED’s alternative airway box:
• jet insufflator;
• Cook retrograde intubation set;
• trachlight with wands;
• needle cricothyrotomy kit;
• Melker cricothyrotomy kit;
• trach hook;
• scalpel No. 10.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content