A small compilation of nurse anesthesia care plans

These anesthesia care plans are meant to inspire nurse anesthesia residents when they are making their care plans. Always make sure you fully understand and "own" your care plan. Your plan must be specific for your patient and should always be with the most up-to-date information.

Double lumen tubes

Advantages

Can perform one-lung ventilation

Create a quiet surgical field along with better surgical visualization

Specifics

One lumen reaches the mainstem bronchus - blue cuff

One lumen ends in the - cuff

The distance from the carinal bifurcation to the left and right bronchus are

  • Left = 4-5 cm
  • Right = 1.5-2 cm

Sizes

  • Left 41, 39, 37, 35, 28, 26
  • Right 41, 39, 37, 35
Female

 <160 cm size 35

 >160 cm size 37

Male

<175 cm size 37/39

>175 cm size 39/41

For both, have sizes above and below

Depth of insertion - 29 cm +/- 1 cm for every 10 cm of height above or below 170 cm

Placement

Lubricate the distal end, including the cuff. Use a MAC blade, insert until the black ring passes through the cords, then remove the stylet. Rotate 90 degrees towards the bronchus you want to intubate.

Tracheal cuff 5-10mL of air, bronchial 1-2 mL of air.

Check placement - both auscultation and fiber optically

  • Bilateral breath sounds with both cuffs inflated
  • Clamp the tracheal side and open it to air - should only have breath sounds on the bronchial side
  • Close the port and unclamp
  • Repeat with the bronchial side - should only have breath sounds on the tracheal side

Ways to improve Hypoxic Pulmonary Vasoconstriction (HPV)

Narcotic Anesthesia

CPAP 5-10 cm to the non-ventilated lung

  • Improve oxygenation

PEEP - 5-10 cm to the ventilated lung

  • Stents airways open

Volatile agent <1 MAC

Early ligation of pulmonary artery - pneumonectomy only

Periodic inflation of non-ventilated lung

Insufflation of oxygen into the collapsed lung

Reduce vasodilator usage

  • Cardene is the best option if needed