Dysphagia 4 - Tracheostomy & Ventilator Flashcards
Identify three types of artificial airways.
Endotracheal tube
Tracheostomy tube
Mechanical ventilation
What is the primary purpose of an endotracheal tube?
Identify the two types of endotracheal tubes.
How long is its intended use?
Describe how it functions.
Name three types of complications associated w/ using these tubes.
It is designed to help a person breath in emergency situation.
Oral & nasal tubes
Temporary use (7-10 days)
It goes thru the pharynx, the VFs & into the lungs. It is also connected to an air source.
Number of complications include hoarseness, VF weakness or paralysis
What is the difference b/w a Tracheotomy & Tracheostomy?
Tracheotomy (i.e. surgical procedure)
- Upper airway obstructed/edema
- Intubation prolonged (>10-21 days)
- Ventilator (use requires trache)
Tracheostomy (breathing tube)–maintains airway
Describe six physiologic changes following a tracheotomy.
- Decreased subglottic air pressure
- Decreased laryngeal excursion
- Poor VF closure
- Poor airway sensitivity/cough reflex
- Taste & smell disrupted
- Increased secretions
In terms of swallowing function after tracheostomy, risk of aspiration is (higher/lower).
After tracheostomy, physiologic changes (increase/decrease) patient risk.
Identify three physiologic changes a tracheostomy patient undergoes.
Higher
Increase
Reduced laryngeal excursion
Reduced airway pressures
Saliva/secretion management
Describe the role of a SLP post-treacheostomy.
- Evaluate & facilitate speech & swallowing
- Help team address psychological issues
- Facilitate patient communication
- Monitor patient progress/Family education
A tracheostomy tube is located near which tracheal ring(s)?
A TT is well (above/below) the true VFs.
Located near second or third tracheal ring.
Well below the true VFs.
Identify the seven parts of a trache tube.
Obturator Outer cannula (Inside Trach) Inner cannula Pilot balloon/line Hub/Lock Neck flange or plate, ties Plug or button
Identify both types of Trache tubes.
Cuffed/Cuffless
Fenestrated/Non-fenestrated
What part of a trache tube signifies the type of tube being utilized?
What part of a TT signifies a cuff is being used?
What type of information doe a trache plate provide?
Pilot Balloon
Pilot Line
Size & type of TT
T/F - Cuffed TT are NOT usually the type of tube placed.
A Cuff helps (?) the TT.
How can you tell if a cuffed TT is inflated or deflated?
False
Stabilize
The balloon will be either fully expanded or flat.
What two areas does a cuffed TT separate?
A cuffed TT aids in what type of protection?
Use of what type of piece on a TT increases a patient’s risk of suffocation?
Identify two types of methods of inflating/deflating a cuffed TT.
Upper from lower airway
Gross aspiraton
Speaking valve
Minimal leak or manometer
Identify four types of hazards associated w/ cuff use.
Overinflation
TE fistula
Rupture
Slippage
A (?) tube allows for greater airflow.
Specifically, this tube allows for > airflow thru what four areas of the swallowing mechanism?
Fenestrated
Vocal folds
Pharynx
Oral cavity
Nasal cavity
Identify two types of risks associated w/ Fenestrated Trache use.
Identify three TT sizes. Which is commonly used?
Identify three TT brands
Why is use of a speaking Valve contraindicated for patients w/ foam-filled tube?
- Risk of granulation tissue in fenestration
- Risk of hemorrhage if pulled at granulation site
- 4 / 6 / 8* mm
- Shiley, Bivona, & Jackson
- b/c it requires a deflated cuff (i.e. they are not fenestrated).
Specialized talking trache is specifically used on which two types of patients?
People on ventilators (i.e. cannot deflate their cuff) or a person w/ a foam filled trache.
Identify six types of complications associated w/ TT use.
Infection
Stenosis
Granuloma
Tracheomalacia
Tracheoesophageal fistula (TE fistula)
Esophageal compression
Describe the basic aspects of a “decannulation plug”.
Removal of the trache
May be gradual (wean)
Trache plug is used before removal.
Describe the process/protocol of conducting a “Trache & Swallowing assessment”.
Conduct a thorough case history review
Conduct an oral mechanism exam
Conduct trial studies
If necessary, Conduct Blue dye testing
Describe the proper trial swallow procedures.
Suction Deflate cuff (if conducting a swallow evaluation) Dry swallow (Finger occlude trache) - Listen (breathing, voice) - Encourage cough/throat clear
Bolus swallow (solids/liquids w/ blue dye)
- Listen (breathing, voice)
- Encourage cough/throat clear
Observe s/s aspiration
Suction
Positive blue dye test results indicate (?).
Negative blue dye test results indicate (?).
T/F - Blue dye testing has HIGH reliability.
What role does blue dye testing have in trache/swallowing testing?
Positive: terminate; try different bolus types.
Negative: continue larger amounts
False
Used a screening tool
Describe the basics of a passy muir speaking valve.
Where does it fit on a trache tube?
It is specifically designed to allow a person to (?).
T/F - It is NOT to be used w/ a cognitively impaired person.
One way valve
Close position valve (vs. open-position)
Come in three different Colors
Fit on the outside of TT
Talk
True
Describe the signs indicating use of a passy muir SV is appropriate.
Patient must demonstrate alertness
Their vitals must be stable
Demonstrate tolerance for cuff deflation
Indicate trache type & size
What do the following passy muir speaking valve colors indicate:
White
Aqua
Purple
Clear
White - Hardly used
Aqua – people on vents or non-vented (preferred)
Purple – just non-vented patients
Clear is for additional air.
Identify seven contraindications for using a PMSV.
Severe stenosis Airway obstruction Foam cuff Patient can’t tolerate cuff deflation Reduced alertness level Malaise/persistent fatigue Unstable vitals
Describe appropriate PMSV assessment procedures.
Cuff deflation
Trial valve placement
Describe the benefits of using a PMSV
T/F - Patient cannot sleep in valve.
Eliminates negative physiologic changes Facilitates swallowing Facilitates voicing Helps patient cough and clear secretions Speeds up decannulation
True
Describe the process for conducting an evaluation for speaking valve use.
Conduct Oral motor exam (incl. head/trunk control)
Determine patient’s Comprehension
Gather Baseline vitals
Determine Cuff deflation tolerance
Assess Voicing qualities
Speaking valve placement (if voicing achieved)
How is voicing evaluated for speaking valve use?
Describe the process of speaking valve placement.
After cuff deflation
Finger occlusion
If voicing achieved . . .
Assess patient’s Vitals
Determine Tolerance & duration
Assess Vocal quality & speech intelligibility
Name the three types of ventilation.
Spontaneous
Manual
Mechanical
Identify four types of Mechanical ventilators.
Endotracheal
Nasal
Tracheal
Mask
Name the four important concepts for mechanical ventilation.
Volume *
Pressure *
Time (Rate)*
Flow *
Explain each of the following mechanical ventilation concept:
Volume
Pressure
Time/Rate
Flow
Volume is how much air is coming into the lungs from the ventilator.
Pressure deals w/ out much force the lungs need to stay inflated.
Time/Rate deals w/ breath cycle.
Flow deals w/ how easy air moves in/out of lungs
T/F - Use of excessive oxygen during mechanical ventilation use can damage the lungs.
In terms of ventilation flow, what does a patient demonstrating the following physical signs indicate:
“Fast breathing” indicates
“Slow breathing” indicates
True
Hyperventilating
Suffocation
Identify six ventilator settings.
What does it mean when a patient needs more oxygen in their lungs?
What is the common number of breaths a person avg. per minute?
- Tidal Volume (Vt)
- Respiratory Rate (RR)
- Flow
- I:E ratio
- FiO2 (Fraction of inspired oxygen content)
- PEEP (Pressure)
Lung damage
8-12 per minute
Identify the following ventilator modes:
CMV A/C IMV/SIMV CPAP PSV PEEP
Control mode (CMV)
Assist control (A/C)
Synchronized intermittent mandatory ventilation
Continuous + airway pressure
BiPAP (Bilevel)
Pressure support (PSV)
Positive end expiratory pressure
What is the difference b/w a person on control vs assisted control mode?
SIMV is preferably used w/ a patient who is ready to do what?
What must a patient be able to do in order to be placed on CPAP mode?
What is the primary objective of place a patient on PEEP mode?
CMV = person is not doing any breathing A/C = person is doing partial work in breathing
Ready to ween off the ventilator
Breath completely spontaneously
PEEP is pressure in the lungs that keep it from collapsing. Keeps lungs open at the end of expiratory cycle.
If using a cuffed TT, what do the following pressures indicate:
Low
High
Apnea
Low pressure indicates Cuff may have deflated, slippage or leakage in the system. As a result lungs are not receiving air.
High indicates a plug in the system.
Apnea means person is not getting a breath.
