Tracheostomy & Laryngectomy

Question 0

What type of trach is this?

Answer 0

Shiley

Question 1

What is a big question you should ask yourself when you have a patient with a trach?

Answer 1

can I provide PPV ?

Question 2

What are the parts of a shiley trach? and what part must you have for in order to ventilate?

Answer 2

1) trach (body, cuff, inflation system, flange with tie downs) 2) Introducer 3) inner cannula w/ 15 mm connector (must have this to ventilate)

Question 3

what is an XLT trach and why is it needed?

Answer 3

insert pic here XLT = extended length tube used when there is excessive distance from the surface of the stoma to the actual trachea

Question 4

What is the perfusion pressure of the tracheal mucosa?

Answer 4

25 cmH2O (I’ve been told this question was on the boards)

Question 5

What are the associated intermediate and long term risk of a tracheostomy?

Answer 5

usually occurs in the following order… ischemia necrosis erosion dilation stenosis (due to granulation after removal of the trach apparatus)

Question 6

Why is Nitrous Oxide a concern with cuffed tracheostomy?

Answer 6

with in 15 min post intubation it can cause the cuff to expand —> lateral wall ischemia development

Question 7

What type of tracheostomy tube is all metal

Answer 7

Jackson

Note : there is no 15mm connection so you have to use a small ETT connector to bag mask Ventilate

Question 8

What type of tracheostomy tube is this?

Answer 8

Montgomery T-tube

Question 9

How would you connect the Montgomery T-tube to the positive pressure ventilation system

Answer 9

Use a ETT connector

Question 10

How do you control airflow and prevent loss of gas out of the patients airway when they have a Montgomry T tube?

Answer 10

Occlude either the stoma portion of the tube or somehow include the patient’s mouth nasal airway

Question 11

What type of device is used to maintain stoma patency for future access?

Answer 11

Trach button

Question 12

What type of treatment equipment is this and what Makes it special?

Answer 12

Kistner trach It allows access for suctioning and also permits speech but cannot use for PPV

Question 13

What type of trach is referred to as a talking trach

Answer 13

Fenestrated trach

Question 14

What type of tracheostomy tube is this and what is the gas pathway when the cuff is not inflated?

Answer 14

Fenestrated tracheostomy tube Gas will flow through the inner cannula as well as around the cuff to the vocal cords

Question 15

In the fenestrated tracheostomy tube, if the inner cannula has been removed and the cap locked on the body with the cuff inflated, Which way will be air flow?

Answer 15

Through the Fenestration and over vocal chords (Producing sound)

Question 16

What type of trach is this?

Notice the shape of the inner cannula

Answer 16

Communi-trach Used for breathing spontaneously and talking

Question 17

Name 2 complications associated with tracheostomy tubes

Answer 17

1) Tracheoesophageal fistula 2). Tracheo-innominate artery fistula

Question 18

Which of the complications of the tracheostomy tube is considered an airway emergency? And how do you treat?

Answer 18

Tracheo-innominate Fistula. Treat temporary by repositioning the tracheostomy tube and Hyper inflating the cuff to tampinade the filstula until the surgery to fix it

Question 19

What has been put in place to provide a guide to replace the inadvertently removed tracheostomy tube?

Answer 19

Stay sutures

Question 20

What is the opening in the skin to the trachea referred to as?

Answer 20

Stoma

Question 21

What is this?

Answer 21

Laryngectomy tube Cannot be used for PPV

Question 22

If you must replace the tracheostomy tube or laryngectomy tube with and ETT during the procedure what type of ETT should you use?

Answer 22

Anode Allows better positioning of the tube since it can be bent more freely

Question 23

What adjunct is this?

Answer 23

Trach Coller

Preferred source of oxygen and humidification for the patient that is spontaneously breathing through the tracheostomy tube or Laryngectomy tube