Chapter 35: Tracheostomy + Laryngectomy Flashcards
What are the three parts of a Shiley classic trach used in a tracheostomy?
Trach
Introducer
Inner cannula with 15 mm connector
Anatomy of a Shiley trach?
Body
Cuff
Inflation system
Swivel flange with tie downs
Describe the flange of a Shiley trach?
Swivel flange with tie downs
In what condition should a Shiley trach be if getting ready to insert?
Balloon should be deflated and stylet should be inserted.
If the stylet is removed and the balloon is inflated, the Shiley trach is said to be in what position?
Operational; ready for PPV or suctioning
A tracheostomy has two parts:
Trach body
Inner cannula
Describe the body of a tracheostomy:
Cuff
Inflation system
Fixed flange with tie downs
15 mm connector
Connector size for trachs?
15 mm
Which type of trach has a swivel flange?
Shiley
In what case would a patient require an XLT (extra length) tracheostomy tube?
If the patient has a lot of extra tissue in their neck area
Perfusion wall pressure of tracheal mucosa?
25 cmH2O
What are some intermediate and long term problems caused by tracheostomies?
Ischemia Necrosis Erosion Dilation Stenosis
What gas can produce significant ischemic lateral-wall injury? How?
Nitrous oxide
If you inflate a balloon, eventually the gas that you use to inflate will seep out. In the case of air, it seeps out of the balloon and escapes, leaving a slight decrease in pressure. In the case of an O2/nitrous mix, it seeps out of the balloon and nitrous expands, rapidly + greatly increasing pressure.
Which trach tube is a single-piece construction?
Kamen-Wilkinson trach
Which trach tube features an adjustable flange?
Kamen-Wilkinson trach
Describe the cuff of a Kamen-Wilkinson trach tube:
foam-filled cuff
What are the distinguishing factors of a Kamen-Wilkinson trach compared to standard or Shiley?
Distinct inflation system
Foam filled cuff
What is a Lanz-pressure regulating valve?
This valve will bounce back and forth as pressure in trachea from tracheostomy tube gets too high and will regulate pressure by emptying any excess air into a larger surrounding balloon.
What are two critical considerations when placing a trach?
There should be no traction on the trach.
Maintain optimum cuff pressure.
Which trach tube is all metal?
Jackson trach tube
Why might a provider choose to use a Jackson trach tube over others?
Infection control
Size of connector for pediatric trach?
15 mm connector
In a Montgomery T-tube, orient the tube to the patient’s airway:
The longer section of the tube points leftward (downward) to the trachea. The offshoot points upward (leftward) to the connector. The shorter section of the the tube points rightward (upward) to the vocal cords.
How do you connect a Montgomery t-tube to a circuit for positive pressure ventilation?
Via 15 mm connector
What is a trach button?
A spacer that keeps trach open to maintain stomal patency for future access
Is a trach button useful for PPV?
No, only used as a spacer
What is a Kistner Trach?
It is a trach that maintains stomal patency for access to suction and permits speech.
Which trach permits speech?
Kistner trach
Is a Kistner trach useful for PPV?
No, only for suctioning and speech
In what way does a talking trach allow speech?
It has a fenestration that allows cephalad gas flow and an inner cannula that is locked into the body; trach is cuffed.
Describe the shape of a Communi-Trach?
The inner cannula/lumen is not circular; it is rounded on the bottom but then flat on top.
Major gland that sits in front of the trachea?
Thyroid gland
What kind of sutures do surgeons use in tracheostomies? Why?
Side-to-side stay sutures so that if the trach somehow slips or comes out, they can easy access the stoma again.
How long after decannulation can you reinsert a trach?
About two weeks
What is the purpose of a laryngectomy tube?
It is a placeholder; NOT useful in PPV
What is the surgical result of a total laryngectomy?
Trachea is anastomosed to skin.
If you wish to supply anesthesia and PPV to patients with trachs and laryngectomy tubes, how do you go about that?
Replace the trach with an anode ETT.
What type of ETT allows you to supply anesthesia to a patient with a trach or laryngectomy tube?
Anode ETT
If the surgeon is working on the upper region (skull, airway) of a patient with a trach/laryngectomy tube, what kind of anode ETT is best?
Caudad anode ETT
If the surgeon is working on the thoracic region of a patient with a trach/laryngectomy tube, what kind of anode ETT is best?
Cephalad anode ETT
Because we do not wish to put traction on a trach after surgery, what is our best option/preferred source for oxygen and humidity for our patient?
A trach collar
