Lecture 2 tracheotomy/ tracheostomy Flashcards
What is the difference between a tracheotomy, and a tracheostomy?
You first do a tracheotomy, which is an emergency procedure that can be temporary & will heal quickly, whereas a tracheostomy is a permanent, long lasting airway in the trachea
- First is a tracheotomy, then possibly made into a tracheostomy
What are the characteristics of a tracheotomy?
- Opening the trachea at any level/point (not the larynx)
- Opening the trachea to create an airway
- Once decision for tracheotomy, it may then be necessary to determine if a more permanent arrangement has to be made
T/F: A tracheotomy is an emergency procedure to open an airway?
TRUE
What is the criteria for turning a tracheotomy into a tracheostomy?
- Pump failure (breathing mechanism, torso, lungs, diaphragm, intercostals)
- Airway blockage (blockage that won’t resolve quickly enough to maintain an airway)
What does pump failure mean? and what else does it include?
- When the muscles for respiration fail not the lungs tissue itself
- Muscles are nonfunctioning
- Flail Chest: Enough ribs or the sternum was broken
- Injury to brain, brainstem, or spinal cord at the cervical level: Paralysis or paresis
What does Airway blockage mean?
- In this case if there is blockage the tracheotomy becomes a tracheostomy
- The larynx could be crushed
- There could be stenosis of the larynx → Keeps coming back
- Possibly a broken or swollen larynx
Patients who are being evaluated for a tracheostomy may require what?
- Either mechanical assistance breathing until the pump (muscle) or lungs can function independently, or maintenance of an airway until the natural airway can be restored.
What are the two reasons for tracheostomy?
- Pump failure
- Airway blockage
What is a ventilator?
- Tube to maintain the airway is pushed through the mouth through the VF and into the trachea
- Done through intubation
- More O2 can be ventilated through the lungs → Raise O2 content
- So if lungs aren’t functioning optimally increase the O2 content of the air into the lungs so they can put enough O2 in the bloodstream
What are the indicators for tracheostomy?
- Length of time on the ventilator
- Difficulty mobilizing secretions
- Airway trauma that won’t resolve quickly
- There can be surgical indications of a tracheostomy being necessary
Why does length of time on a ventilator matter when evaluating a tracheostomy?
- VF are short and thin, having a tube placed between them for long term is damaging to them, as well as to the ENTIRE VAGUS NERVE COMPLEX in the larynx.
- risks become absolute after a long period of time
- May be edema/swelling right at the VF
- Dental abscesses (caused by intubation)
What is the longest time you want someone to be intubated through the larynx?
5 - 7 days
Why does difficulty mobilizing secretions matter when evaluating a tracheostomy?
- Because we are suppose to swallow a couple times per minute, so we need to evaluate how often they are swallowing (will allow s to figure out their mucous secretions)
Why are surgical indications of a tracheostomy being necessary when evaluating a tracheostomy?
.- Skull or dural surgeries: Tracheostomy may be performed b/c patients who have this have swelling & that swelling results in pressure onto the brainstem which in turn will l effect the breathing
- Head and neck cancers: Indications → Pressures on the brainstem, Cancer is interfering with the larynx Tumor in throat/jaw is closing the airway Laryngectomy
- TBI
How do you manage secretions?
- Suction!
What is suction?
The removal of secretions from the airway
T/F: Suction is a sterile technique?
FALSE, it is a clean technique
What must we always do when working with tracheotomy/tracheostomy clients?
WASH OUR HANDS
What must we do if a patient is distressed while we are suctioning?
Review our technique, there should be no pain during this procedure
What things do we check for when evaluating secretions?
- How does it look?
- Thickness
- Smell
- Is there blood?
