Critical Care - Tracheostomy

Question 1

What is a tracheostomy?

Answer 1

A surgical opening in the anterior wall of the trachea

Question 2

What is a tracheostomy for?

Answer 2

To facilitate ventilation/respiration

Question 3

Indications? (4)

Answer 3

To maintain an airway, to bypass obstructions, assist in removal of secretions, weaning from a ventilator

Question 4

Pros? (6)

Answer 4

Increased patient mobility, increased patient comfort, ease for suctioning, decreased anatomical dead space, enables communication, decreased risk of infection

Question 5

Cons? (6)

Answer 5

Blocked/displaced tubes, infection, long term tracheal damage, aspiration risk, scar formation, psychological effects

Question 6

Humidification with the trache? (3)

Answer 6

Drying of secretions, reduced mucociliary transport, reduced airway pressure.

Question 7

Difference between single and dual cannula?

Answer 7

Dual cannula has an outer and inner tube - used for those with high levels of secretions. Inner tube can be removed to be cleaned and prevent blockages.

Single cannula is a single tube - Maximises space for the airway.

Question 8

Care of the trache? (4)

Answer 8

Cleaned at least once a day, inner tube cleaned/changed (if a dual cannula), tube changes every 28 days, emergency equipment always nearby

Question 9

Importance of weaning/decannulation? (4)

Answer 9

Decreased risk of complications, decreased patient stress, psychological boost for patient, decreased dependency of patient on MDT

Question 10

Criteria for trache weaning? (6)

Answer 10

Primary caused resolved/manageable, adequate nutritional state, adequate sleep, psychological support, able to protect airway, spontaneous breathing off vent for 24-48 hours

Question 11

Reasons for not decannulation? (7)

Answer 11

Decreased sats, changes in HR, increased RR, increased WOB, inability to cough/expecturate, fatigue, stridor