5.1 Tracheostomy

Question 1

What is the first step of the respiration system?

Answer 1

Ventilation: Movement of air into and out of respiratory passage and lungs

Question 2

What is the second step of the respiration system?

Answer 2

Gas exchange between air in the lungs and blood

Question 3

What is the third step of the respiration system?

Answer 3

Transport of O2 and CO2 in the blood

Question 4

What is the fourth step of the respiration system?

Answer 4

Gas exchange between the blood and tissues

Question 5

What is tracheostomy?

Answer 5

Surgery to create opening in trachea through the neck

Question 6

What is a tracheostomy tube?

Answer 6

A 2-3” long curved tube placed in stoma (hole at base of neck)

Question 7

What are the two types of tracheostomy tubes?

Answer 7

Can be cuffed or uncuffed

Question 8

What are the different reasons why someone would get a tracheostomy tube? (10)

Answer 8

• Tumors
• Laryngectomy
• Subglottic stenosis
• Subglottic web
• Tracheomalcia
• Vocal fold paralysis
• Injury to larynx or mouth
• Obstructive sleep apnea
• Burns
• Neuromuscular diseases (effecting diaphragm)

Question 9

What are the two most common reasons for a pediatric trach?

Answer 9

• Genetic (syndrome)

- Accidents

Question 10

What are the differences between pediatric pharynx anatomy and adult pharynx anatomy? (4)

Answer 10

• Smaller airway, more easily obstructed
• More soft tissue (more likely to have edema)
• Airway more prone to spasms
• Less cartilage support, more prone to collapse

Question 11

What are the advantages of an endotracheal tube?

What are the disadvantages? (3)

Answer 11

• No surgery, quick/easy
• May damage vocal folds
• Typically less tolerated by patient
• Limits oral experiences with communication and eating

Question 12

What are the advantages of a tracheostomy tube? (5)

What are the disadvantages?

Answer 12

• Many benefits (see above)
• Easier to manage secretions around vocal tract
• Easier to wean from mechanical breathing with trach
• More comfortable than intubation
• More options for oral communication and feeding
• Surgery

Question 13

Slide nine

Identify the parts in the picture

Answer 13

• 15mm adapter or oral end
• Balloon and cuff secure airway
• Flange at proximal end to secure oral end to present from entering oral cavity

Question 14

What is the outer cannula of the tracheostomy tube?

Answer 14

Outside wall of trach, remains in place to keep airway open

Question 15

What is the inner cannula of the tracheostomy tube?

Answer 15

Fits inside outer, comes out easily for cleaning, can be disposable

Question 16

What is the flange of the tracheostomy tube?

Answer 16

Secures trachea to neck, ties to go around neck

Question 17

What is the obturator of the tracheostomy tube?

Answer 17

Used only during insertion process and removed after that

Question 18

What is the button of the tracheostomy tube (plug, cap, or cork)?

Answer 18

Have to first remove inner cannual and used only with cuffless trach

Question 19

What is the cuff of the tracheostomy tube?

What does it do?

Answer 19

Balloon that surrounds the outer cannula

Prevents air from escaping around tube from lower to upper airway

Question 20

Cuffed tube can be ____________ or not

Answer 20

fenestrated

Question 21

What is a fenestrated tube? (2)

Answer 21

A fenestrated tracheostomy tube in situ.

Airflow passes through the single fenestration

Question 22

A tracheostomy tube can have a __________ or ___________ fenestrations?

Answer 22

Single

Multiple

Question 23

Placement of a what blocks the fenestration?

Answer 23

Nonfenestrated inner cannula blocks the fenestration

Question 24

What are the different types of tracheostomy? (6)

Answer 24

• Temporary
• Permanent
• Emergency
• Percutaneous
• Minitracheostomy
• Cricothyroidotomy

Question 25

What are the indications that someone would need a tracheostomy? (5)

Answer 25

• To provide and maintain a patent airway
• To enable the removal of tracheobronchial secretions
• To permit long term positive pressure ventilation
• To improve patient comfort
• To decrease the work of breathing and increase volume of air entering the lungs

Question 26

What are the components of a tracheostomy tube? (6)

Answer 26

• Size ranges from 2.5mm-11mm
• Curved tube
• Inflatable cuff (optional)
• Flanges with holes
• Fenestrated (optional)
• Tube bladder

Question 27

What are the basic three steps of surgery for a tracheostomy?

Answer 27

• Surgical cuts in the tracheal rings
• Creates tracheal opening
• Inserts tracheostomy tube