Provisional Airway Safety Package for NOECCN

Formulated as a result of audit completed 2015:

In the Wake of NAP 4: Have we Learnt Anything?

An Audit of Availability of Emergency Airway Equipment and Guidelines in A&E and ICU in the Northern School of Anaesthesia and ICU, UK

1. Suggestions for contents of Difficult Airway Trolley2. Emergency Induction Checklist3. Can’t Intubate, Can’t ventilate Guidelines4. Tracheostomy Emergency Guidelines5. Suggestions for contents of a tracheostomy box

Guidelines should be immediately available

In addition, our audit would strongly advocate the use of capnography at induction and continuously in the intubated patient.

1. Contents of Difficult Airway Trolley (1)

Plan Drawer Contents

A 1 Bougie (? On side of trolley), short handled laryngoscope, McCoy blade +/- straight blade, video laryngoscope

B 2 LMA 3, 4, 5 +/- 2nd generation 3, 4, 5, intubating LMA 3, 4, 5, Aintree intubating catheter (? On side of trolley), awake fibre optic adjuvants (or stored separately nearby

C 3 Facemasks & OP and NP airways (various sizes)LMA/proseal LMA

D 4 Large bore cannula device, scalpel, tracheal hook/dilator, bougie, small ETT (6 & 7)

D 5 Jet ventilation cannula, ventilation system (jet)

2. Emergency Induction Checklist (2)

3. Can’t Intubate Can’t Ventilate Guidelines (3)

4. Emergency Tracheostomy Guidelines (4)

5. Contents of Emergency Tracheostomy Box (5)

Spare tracheostomy tubes: the same size and a size smaller Tracheal dilators- sterile packed Stitch cutter- if the tube is sewn in 10ml syringe- for cuff deflation Scissors- to cut neck tapes in the case of emergency Spare trachy holder Spare trachy dressing Catheter mount Yankeur sucker

References

1. Difficult Airway Society. Setting up a Difficult Airway Trolley [Internet]. 2014. [Accessed 22 April 2016]. Available from: https://www.das.uk.com/content/difficult_airway_trolley

2. Cook TM, Woodall N, Frerk C. Fourth National Auidt Project. Major complications of airway management in the UK: results fo the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Br J Anaesth 2011:106:617-631. Available from: http://www.rcoa.ac.uk/index.asp?PageID=1089. [Accessed 22 April 2016]

3. Difficult Airway Society. DAS guidelines for management of unanticipated difficult intubation in adults [Internet]. 2015. [Accessed 22 April 2016]. Available from: http://www.das.uk.com/guidelines/das_intubation_guidelines

4. National Trachestomy Safety Project. Emergency tracheostomy management - Patent upper airway [Internet]. 2012. [Accessed 22 April 2016]. Available from: http://www.tracheostomy.org.uk/Templates/Algorithms.html. ( Original article: McGrath BA, Bates L, Atkinson D, Moore JA. Multidisciplinary guidelines for the management of trachestomy and laryngectomy airway emergencies. 2012. Anaesthesia 67(9): 1025-41.)

5. National Tracheostomy Safety Project. Tracheostomy Training Resources. A guide to tracheostomy management in critical care and beyond. North West Regional Tracheostomy Course. [Internet]. 2009. [Accessed 22 April 2016]. Available from: http://tracheostomy.org.uk/Tracheostomy/Trachy%20Printed%20Materials/NW%20Regional%20Tracheostomy%20Background%20Resources.pdf.