Policy & Procedure
Shiawassee County Medical Care Facility
Approved by Social Services Board
Date: 12/31/99
Revised:
Choking (Obstructed Airway Clearance)
Basic Responsibility: Licensed Nurse, Nursing Assistant and any person in the Facility with
expertise in Airway Clearance (Heimlich Maneuver)
If performed by individuals other than those listed in Basic Responsibility, check all that apply.
Procedure Performed by: CENA LPN RN PT OT
Purpose
To clear airway of blockage of foreign object or food.
Definition: The Heimlich Maneuver is a technique which involves sudden compression of the lungs
to provide air pressure within the trachea to eject an object from the throat. The Heimlich Maneuver
may restore airway patency and prevent anoxia by removing the airway obstruction.
General Resident Rights Guidelines
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If resident is in his/her room, knock on the door, wait for a response and identify yourself.
Explain advance directive rights to resident on admission; include the resident’s family and
representatives.
Have the physician explain the following to the resident and the resident’s representatives
to assist in making advance directive decisions:
o Life-sustaining procedures to the resident.
o Risks and benefits of the procedures to the resident.
o Adverse effects and/or complications of the procedures to the resident.
Include resident’s family and surrogate health care decision-makers in explanation of the
procedure and in care planning when possible.
General Guidelines for Assessment may include, but are not limited to:
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Inability to speak.
Presence/absence of respirations.
Rhythm and quality of respirations.
Cyanosis.
Level of consciousness.
Respiratory distress.
General Infection Control Guidelines
1. Observe (standard) universal precautions or other infection control standards as approved
by appropriate facility committee.
2. Wash your hands before and after all procedures. Wear gloves when appropriate.
3. Dispose of disposable equipment appropriately.
4. Thoroughly clean all equipment used and return to appropriate storage area.
5. Dispose of soiled linen appropriately.
Equipment
No extra equipment needed.
Procedure
1. Look for signs and symptoms of distress:
a. Unable to speak or breathe.
b. Turning blue and/or unconsciousness.
c. If resident is coughing, allow him/her to cough to dislodge the object himself.
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Policy & Procedure
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Date: 12/31/99
d. Coughing is a defense mechanism of the body which serves the purpose of
ejecting foreign objects from air passages.
The universal sign for respiratory distress is holding the throat with the hands.
Stand behind the resident with your arms around his/her waist and tilt forward.
Grasp your fist with your other hand and place in the resident’s abdomen slightly above
the navel and below the ribcage.
Press your fist into the resident’s abdomen with a quick, upward thrust.
Repeat several times, if necessary.
This can be done with the resident sitting or standing.
Resident Lying Down (Unconscious)
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Hyperextend the head gently to open the airway. Remove dentures if present.
Open the resident’s mouth and sweep with the finger to remove any foreign object or food.
Kneel on the floor, straddling the resident’s legs.
Place the heel of both hands on the resident’s abdomen slightly above the navel and below
the ribcage.
5. Press with a quick upward thrust.
6. Repeat if necessary.
7. This procedure should dislodge any foreign object in the airway and allow the resident to
breathe.
If Resident Becomes Unconscious
1. Position resident on back, face up, and delegate a specific person to call paramedics and
resident’s attending physician.
2. Open the airway by hyper extending head; look, feel and listen for respiration.
3. Attempt to ventilate.
4. If unable to ventilate, turn resident on side and give four quick back blows.
5. Sweep the back of the throat with your finger in an attempt to clear the obstruction.
6. Give four abdominal thrusts as described above for resident lying face up.
Note: Do not attempt abdominal thrusts on a pregnant resident.
7. Repeat above sequence as necessary.
8. If the obstruction is removed, open the airway. If no respirations are detected, assess for
absence of heartbeat. If no respirations and no heartbeat are present, start
Cardiopulmonary Resuscitation. Unless resident has issued an advance directive for no
CPR.
Prevention of Obstructed Airway
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Cut food into small pieces.
Chew food slowly and thoroughly, especially if resident is wearing dentures.
Avoid laughing and talking during chewing and swallowing.
Avoid excessive intake of alcohol before and during meals.
Feed the resident slowly.
Do not give liquids when mouth is full of food.
Possible Related Minimum Data Set Triggers
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Delirium.
Visual function.
ADL functional/rehabilitation potential.
Psychosocial well-being.
Nutritional status.
Dental care.
Dehydration/fluid maintenance.
General Documentation Guidelines
1. Date and exact time symptoms of obstruction noted.
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Policy & Procedure
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Date: 12/31/99
Procedure performed.
Notification of paramedics (exact time).
Notification of attending physician (exact time).
Notification of resident’s representative.
Resident’s response to procedure to relieve obstruction.
Exact time airway obstruction was relieved.
Condition of resident after obstruction was removed, including vital signs and neurological
signs.
Exact time paramedics responded to call.
Physician’s orders for continued care of resident (including telephone order and noting of
orders).
Frequent follow-up monitoring and assessment of resident’s condition.
Signature and title.
General Resident Care Plan Documentation Guidelines
Problem
 Identify problem that caused the obstructed airway.
 Consider identifying possible risks and complications.
Goal
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List MEASURABLE goal(s) to be accomplished related to stabilizing the condition that
caused the obstructed airway.
List target date.
Each Approach
 List instructions, unique to this resident, for monitoring and care of condition that caused
the obstructed airway.
 List preventive measures.
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