Emergency Surgical Procedure And Feeding Tubes Flashcards
How do you treat an upper airway obstruction that is expected to reproved with appropriate treatment?
Temporary tracheostomy
Eg
Brachycephalic airway disease
Largyneal paryalysis
Mass (treatable)causing obstruction of upper airway
Oropharygneal or laryngeal trauma or foreign body
T/F: you should use the largest size that can be easily accommodated by the trachea for a tracheostomy
True
How is the patient positioned to place a tracheostomy tube?
Dorsal recumbency with neck placed over a rolled town
Clip and prep from mid mandible to manubrium
How is a tracheostomy tube placed?
Ventral midline incision 4-5cm to caudal edge of cricoid
Dissect between strap muscles — gelpi retractors aid in visualization
Transfer expense interannular incision (at 3-4 or 4-5 rings)
Place stay sutures around tracheal rings cranial and caudal to incision
Pull ET tube if resent
Remove obturator and replace with inner cannula
Can partially close incision if too long
Umbilical tape used to secure tube around neck
What nursing care is required for tracheostomy tubes?
Continuous monitoring
Removed inner cannula and replace with new one :
Nebulize 20 mins Pre-oxygenate for 3-5mins Suction trachea with sterile suction tip to level or carina Oxygen for 3-5mins Replace cleaned inner cannula Clean skin around tracheostomy incision Replace tube every 24hours
Complications that can caries from tracheostomy?
Tube occlusion — respiratory distress and death (mucous plug, dried secretions within tube)
Airway suctioning — hypoxemia, atelectasis, vagally mediated bradycardia and collapse
Pneumomediastium
Surgical site infection
Coughing, gagging, vomiting
Aspiration pneumonia
How do you remove a tracheostomy tube?
Challenge patient
- deflate cuff
- temporarily remove tube
- place a smaller tube
Allow site to heal by second intention
Suturing site can result in SQ emphysema that can progress to pneumomediastum or pneumothorax
Purpose or thoracocentesis?
Therapeutic or diagnostic
- can be performed with local block and sedation
- useful in patients in distress due to pleural effusion or pneumothorax — PRIOR to chest rads and thoracotomy tube placements
Generally, what location do you do thoracocentesis?
6th, 7th, 8th intercostal space, near costochondral junction or pleural effusion, mor dorsal with pneumothorax
What are thoractostomy tubes used for?
Pneumothorax
Pyothorax
Hemothorax
Placed aspectically under generalized anesthesia
How do you pick tube size for thoracostomy tubes?
Based on need for evacuation
- larger tube for supperative effusion
- smaller tube for air
Width of tube should be
how long should a thoracostomy tube be?
Should start dorsal 1/3rd of thoracic wall at 7-9th intercostal space and end at the point of the elbow
How do you place a thoracostomy tube?
Incision at dorsal 1/3rd of ICS 10-12 (2-3 rib spaces caudal to desired intercostal entry point
Secure tube with Kelly hemostat and advance tube sQ and cranially
At ICS 7-9, reposition tube perpendicular to thorax and apply pressure to hemostat and tube through intercostal muscles
Advance catheter with trochar/hemostat prior to feeing catheter, then advance to ICS 2-3rd as trochar is removed
Cap or clamp tube
Secure with purse string and finger trap suture pattern (non absorbable nylon)
T/F: if position of a thoracostomy tube needs to be change, you can back out the tube but not insert if further into thorax
True
What is used to ensure a close thoracotomy tube system?
C- clamp
Christmas tree adapter
3-way stop-cock
Wire/nylon suture
