06 Flashcards
Two types of inner cannulas
RE usable and disposable
How can you tell if an inner cannula is reusable?
It will twist and lock into place when blue dots line up
Two most common sizes for trach sizes for adults
6 and 8
Where should you always have a spare obturator?
At the bedside
Two main functions of an obturator
To help place outter cannula into stroma and decrease chance of trauma to the trachea. ***Inner cannula is taken out while obturator is used to place.
What is the main advantage of percutaneous dilation trach?
It can be done at bedside, which saves a ton of money due to not having to transport/book a surgical suite
What does the pt need to be capable of in order to get bedside percutaneous dilation?
Pt must be able to handle large leak around the ETT
Where should the trach be positioned in comparison to the carina
3-6cm above carina
Most important thing to do when placing someone onto theventilator or back on a ventilator
Make sure pressures and volumes are good. Meaning if you are giving them 400ml TV you should be getting 400ml back.
How can you assess for a pnuemo after trach placement?
Some sub Q is okay but if there is a lot there is probably a pnuemothorax
Normal cuff range and how often it is checked
Pressure 20-30cmH2O/ 15-25mmHg. Checked Q8 hours
How can you prevent stenosis?***
Ensure that the trach ties are snug and not too loose. If it is loose it will allow the cannula to move around and cause damage inside. (can occur in multiple areas)
How to prevent tracheomalacia
Keep good cuff pressure and good trach tie.
When is someone affected by tracheomalacia?
If they have floppy cartilage rings.
**Sorta collapses during EXPIRATION
If you keep checking your cuff pressure and it is increasing, what does this indicate?
Glottic Edema
Cause of tracheal granuloma
Occurs at the STOMA SITE. Due to abrasion or possible allergy to material.
A TE fistula is caused by what? And what is the primary way to diagnose this?
Caused from increased cuff presures of long term trachs. A fistula will cause frequent aspiration
How often do you change an inner cannula?
Q daily
RT will typically change out trach, but when will the physician do it instead?
If its less than 5 days old, pt is unstable, or edema around the site.
Typically how often is a trach tube changed out?
Usually around one month
***Fenestrated trachs may be more frequent
Which trach can allow for bypassing anatomical abnormalities
XLT
Two safety factors to keep in mind with XLT
Must monitor closely via x ray (want 3-6cm above)
DO NOT take to MRI
MAin reason to use XLT
It is intended to be temporary until a custom sized one can be made
What pt is an XLT proximal typically used for?
Usually very obese people because the proximal side is longer to reach through the extra neck fat/tissue
XLT distal would be used for what pt?
A pt with an abnormally long trachea
Hi-Lo Trach purpose
Helps prevent VAP because it has continuous suction above the trach. Has a cuff that can handle higher pressures (up to 40cmH2O)
Standard settings for Hi-Lo Trach
continuous suction set at -20cmH2O, cuff can inflate to 40cmH2O.
What does the fenestrated trach help with?
It acts as a normal trach for a ventilator with inner cannula in. If you take this inner cannula out, the patient can attempt to breath normally through their upper airway thanks to holes in the fenestrated trach.
What is the main purpose of a fenestrated cannula?
Helps person wean after no longer being on ventilator
How can a fenestrated cannula cause granular tissue?
if the inner cannula is kept out too long, the tracheal tissue can grow into the hole located on the outter cannula.
How do you suction someone with a fenestrated cannula?
Remove the plug/cap and replace the inner cannula in order to hook up to mechanical ventialtion
Which Trachs do you not want to take to MRI?
Jackson and XLT
Which cuff would you record a volume instead of a pressure?
Bivona TTS
Doesn’t have a pilot balloon, port is closed during insertion
Wilkenson/Bivona foam cuff. When it is placed, the port is opened and cuff self inflates
What is the steps of troubleshooting a trach?
- DEFLATE CUFF AND O2
- Try to pass suction catheter down trach to asses obstruction
- Pull out inner cannula to look for obstruction
- Replace the trach (spare at bedside)
Why do you need to deflate cuff prior to placement of a passy-muir valve
If you dont, they will inhale air, and then wont be able to exhale the air due to the inflated cuff and the one way valve located on the valve on the outside.
blue vs purple
blue valves are used with ventilation
purple is used for spontaneous breathing off the ventilator
Ostomy vs stoma
ostomy is the incision created for the trach tube. Stoma is just the hole without the tube in it.
How long until a trach is being considered?
10-14 days
Glottic edema
Swelling of the airway due to cuff pressure*
How is a TE fistula typically diagnosed?
Consistent aspiration
How often is trach care performed?
Q 8 hours and prn***
What type of trach is common in pediatrics?
single cannula trachs**
They dont have an inner cannula and usually no cuff
Main benefit of Hi Lo trachs**
Prevents aspiration and VAP via continuous suction as well as being able to inflate cuff MORE than 20-30 (it can go up to 40)
***In order to use a fenestrated trach on the ventilator, what two things need to be done?
Inner cannula needs to be in place as well as DEFLATING the cuff
**A Lanz trach tube will always do what?
keep cuff pressure at 34cmH2O maximum.
**Put 40ml of air into pilot balloon
**What pressure does the foam cuff inflate to?
Always automatically inflates to 1 atm of pressure
**3 ways to decannulate
Progressively smaller trach tubes, fenestrated trach, or trach buttons
What pt is indicated for a trach button/plug?
anyone that needs to keep a patent stoma. Neuro patients use them frequently
What are the criteria for someone to be a candidate for weaning?
- ability to cough 2. no infection 3 patent airway 4 secretion clearance 5 Passes a swallow test.
**What do you do if you place an LMA and arent getting ventilation?
REPOSITION it, it likely just folded the glottis over the wrong way
Which specialty airway is used for a spinal injury?
LMA
What two areas does the King Airway seal?**
Esophagus and oropharynx
Where should the king airway usually be placed?**
into the esophagus
Main difference between combitube and king airway
can go into the trachea or esophagus.
If the combitube goes where is usually does (the esophagus) which tube do you bag
Bag the blue one….if it is placed in trachea you would bag through the shorter port
