Managing an airway is one of the most high-stakes responsibilities in critical and post-acute care setting. Whether the patient is sedated, ventilated, recovering from surgery, or transitioning to an LTACH (long term acute care hospital), or rehab, the stability of airway devices can be the difference between a routine day and a catastrophic event.
Airway devices are utilized in ambulances before hospitalization, as well as in the emergency departments (EDs), operating rooms (ORs), and intensive care units (ICUs).
Here’s a quick, practical rundown of the most common airway devices and why securing them properly is not just good practice, it’s a medical and legal must.
Bag-Valve Masks (BVMs or Ambu-Bag)
BVM is a handheld ventilation device used to deliver breaths to patients who aren’t breathing adequately on their own. It is a one- or two-handed technique utilized for airway management in both adult and pediatric populations and in preparation for intubation.
Endotracheal Tubes (ETTs)
ETTs are the go-to for airway protection and mechanical ventilation. They are considered an advanced airway because they bypass the upper airway completely, even slight migration can result in compromise of patient’s respiratory status.
Intubation can be performed using video laryngoscopy (VL), direct laryngoscopy (DL), or fiberoptic techniques.
Key risks:
- Accidental extubation
- Right mainstem intubation
- Esophageal intubation
- Respiratory failure, either hypercapnic (elevated carbon dioxide) or hypoxia (low oxygenation)
- Vocal cord damage
- Pneumothorax (collapse lung)
- Airway edema (stridor)
- Trauma
Laryngeal Mask Airways (LMAs)
LMAs offer a less invasive airway option for procedures or short-term ventilation needs. They’re easier to place but not as protective against aspiration. Other advanced airway devices include Combitubes, King tubes, and I-gels.
Tracheostomy Tubes
Commonly used in long-term ventilation, neuro patients, and those who can’t tolerate prolonged ETTs. Tracheostomies are lifesaving—until they’re not.
Key risks:
- Accidental decannulation, especially within the first 7–10 days
- Obstruction from mucus plugs
- Stoma breakdown or poor stabilization
Early dislodgement in a fresh trach is a true airway emergency and often fatal if not recognized and corrected immediately - Hemorrhage from major vessels
- Fistulas
- Stenosis (occlusion or narrowing)
Cricothyrotomy (or Cric)
A cricis an emergency surgical airway created through the cricothyroid membrane when traditional methods like intubation, BVM ventilation, or supraglottic devices fail.
Nobody wants to do one, but when you need it, you need it right now. This is the “can’t intubate, can’t oxygenate” (CICO) solution — the moment when all roads lead to the neck. It is the last resort for life saving airway.
Indications
Think immediate life threat due to inability to ventilate:
- Severe facial trauma
- Airway obstruction above the cords
- Massive swelling (anaphylaxis, burns, angioedema)
- Failed intubation with failed supraglottic rescue
- Upper airway hemorrhage
- Inability to maintain oxygenation with BVM
Relative Contraindications
- Children under ~8–10 years → prefer needle cric or alternative techniques
- Distorted anatomy where landmarks cannot be palpated
- Expanding neck hematoma (increases difficulty)
Nasopharyngeal Airways (NPAs)
The humble NPA gets underrated. They maintain patency in semi-conscious patients and during transport.
Key risks:
- Incorrect sizing
- Dislodgement
- Trauma or epistaxis (nosebleed)
Why Securing Airway Devices Is Non-Negotiable
No matter the device, movement is the enemy. Inadequate taping, worn stabilization devices, or poor documentation of tube position leave dangerous gaps in patient safety.
Airway device placement should be checked by capnography (carbon dioxide detection), inspection and auscultation, esophageal detector, or by imaging with chest x-ray.
Medical implications of dislodgement may include:
- Hypoxia or anoxic brain injury
- Aspiration
- Loss of airway with failed re-intubation
- Hemorrhage or airway trauma
- Cardiac arrest
Legal implications can be just as serious:
- Claims of negligent monitoring
- Failure to follow standard of care
- Inadequate documentation of tube position, securement, or reassessments
- Wrongful death suits related to airway loss
- Liability exposure for hospitals, nurses, and providers—especially when securement protocols exist but aren’t followed
Bottom Line
Airway devices save lives only when they stay exactly where they’re meant to be. Vigilant securement, reassessment, and documentation protect the patient and the care team.
And from a legal standpoint, dislodged airway devices account for a significant number of negligence claims tied to monitoring failures, documentation gaps, and breached in standards of care.
Key Takeaway
Airway devices save lives every day, but only when they stay where they’re supposed to. Vigilant assessment, proper securement, and clear documentation protect the patient—and everyone involved in their care.
Call to Action
If you need a critical care nurse practitioner to provide a tailored educational approach on airway devices across a variety of clinical settings, make sense of the standards, and enhance patient safety, our team is ready to support you.
