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CBRC > Manage Specialized Airways > Flashcards

Manage Specialized Airways Flashcards

1
Q

Evac Tubes

A

Have a port that opens above the cuff to remove secretions collected above the cuff

Port connected to 20- 30 mmHg suction

Outer diameter is 0.8 mm larger thus use smaller sizes 7.5 ETT for males and 7.0 for females

Reduces ventilator acquired pneumonia

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2
Q

Anode Tube

A
  • Aka…armouredtube
  • has metal rings (steel reinforcing wire wound spirally within the wall of tube) inside tube
  • Allows bending of tube without occlusion,
  • Used during surgery
  • Available in different sizes, cuffed and uncuffed
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3
Q

Advantage of Anode Tube

A

Prevents kinking and collapse of tube under external pressure

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4
Q

Disadvantage of Anode Tube

A

Once kinked it does not rebound to original shape

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5
Q

Endotrol Tube

A

Endotroltube has small trigger to angle end of tube anteriorly during intubation.

Particularly well suited for blind nasal intubation or with c- spine precautions.

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6
Q

Rae Tubes

A

Feature a preformed curve that directs airway connection away from surgical field without kinking tube

Available in different sizes, oral and nasal types, with or without a cuff

It can be difficult to pass a suction catheter through tight bends.

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7
Q

Double Lumen Endotracheal Tube (DLET)

A

Bifurcated ETT allow us to independately ventilate each lung

One tube is cuffed and position in one of the mainstem bronchus whereas the other will remain in the trachea

Can include a tracheal/carinal hook

Each lumen will have to be connected to seperate ventilators

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8
Q

Carlenstube

A

(left main stem bronchus)

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9
Q

White Tube

A

Right Main Stem Bronchus

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10
Q

Robertshaw

A

Will enter into either the right or left mainstem bronchus

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11
Q

Why Use a DLET

A

Isolate one lung

Thoracic Surgery (ex. pneumonectomy)

Lung lavage for thick tenacious secretions

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12
Q

What Conditions Can DLET Be Used For

A
  • Necrotizing pneumonia
  • Lung abscess
  • Pulmonary embolus
  • Lungs with markedly different compliance and resistance (such as single lung transplant)
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13
Q

Laser Tubes Charateristics and Advantages

A

Will be used during laser surgery as conventional ETT will ignite or the cuff may be perforated

Tubes will have a fire resistant coating that can get damaged but will not ignite

These are metal tubes with a non-reflecting coating avaliability and the cuffs are filled with water or saline, and there may even be two cuffs or a blue marker to indicate perforation

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14
Q

Laser Tubes Disadvantages

A

Stiffer

Bulkier

Less Stable

More likely to cause tissue damage

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15
Q

Bronchial Blocking Tube

A

Single lumen tube that has a extra channel fused along the length and contians a dirct blonchus blocking cuff in order to isolate a lung

Blocker cuff can be advanced or retracted on its separate tube which has both pilot and suction channels

Allows for active lung deflation by syringe or suction on blocker lumen

Used during surgery when one lung is collapsed while other is maintained for oxygenation and ventilation

Also used with medical conditions such as massive hemoptysis(ruptured pulmonary artery)

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16
Q

Bronchial Blocking Tube Advantage

A

Allows greater visualization and less movement within the operative hemi-thorax

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17
Q

Bronchial Blocking Tube Disadvantage

A

•Increased risk of CO2 retention compared to DLET

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18
Q

Jet Tubes

A

Will allow for jet ventilation

Monitoring/irrigation lumen that will enter the tube at the tip

Insufflation of lumen that enter ~2.5 cm before tip

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19
Q

ETTs with additional ports

A
  • ETTshave medication port embedded in tube
  • Useful in emergency when vascular access not established
  • Meds can be instilled without interrupting ventilation
  • ETTs come with ports to provide supplemental O2or to measure distal airway pressures
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20
Q

Foam-Cuffed Tubes

A

Foam- cuffed or Kamen- Wilkenson tubes are not commonly used

Sealing pressure relies on ‘recoil forces’ of covered internal foam

Cuff self- regulates when pilot tube is exposed to atmosphere

Active aspiration of air is required for actual insertion or removal

Injection of air into cuff can turn it into a high pressure system

Air leak noted around cuff with high pressures such as 45- 50 cmH2O

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21
Q

Policy- Traheal Stent Insertion

Equitment

A

PPE

Emergency Artifical Airway Kit

Trach Tube Change Toolbox (recommended)

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22
Q

Policy- Traheal Stent Insertion

Trach Tube Change Toolbox

A

Tracheostomy dressing tray

Drain sponge

Normal Saline

Suction supplies

Tracheal stent for insertion

Allis clamps or equivalent alternate clamp (if applicable)

Securement device, if required

Cork, if required

Syringe, 10 mL

Water soluble lubricant

Scissors and / or suture removal kit

Pulse oximeter

23
Q

Policy- Traheal Stent Insertion

Enteral Feeds

A

Request PHCP hold enteral feeds for procedure to minimize aspiration risk.

Before you insert you want to ask patient to cough. If unable to clear secretions, suction tracheostomy and mouth as indicated.

24
Q

Policy- Traheal Stent Insertion

Preferred Position

A

Optimize patient position for procedure.

Note: The preferred position is supine with the head slightly extended.

25
Q

Policy- Traheal Stent Insertion

Sterility

A

Don sterile gloves. Prepare tracheal stent for insertion while maintaining the sterility of the stent.

26
Q

Policy- Traheal Stent Insertion

For Montgomery® tracheal stents being inserted with allis clamps:

A

Apply water soluble lubricant to the shaft of the clamp prior to insertion into the stent.

Clamp one or both of the flanges

Apply water soluble lubricant to the outside of the stent prior to insertion

27
Q

Policy- Traheal Stent Insertion

Removing the Trach

A

Remove dressing, remove tracheostomy securement device while holding the tube in place, and deflate the cuff if present.

Ask the patient to take a deep breath and remove the tracheostomy tube following the curvature of the tube.

28
Q

Policy- Traheal Stent Insertion

Stoma Care

A

If possible, perform stoma care and assess the stoma for tissue health, color, size and shape, and the stoma may be occluded to assess breathing and voice.

29
Q

Policy- Traheal Stent Insertion

Securign Stent

A

Secure stent with face plate or ring washer.

30
Q

Policy- Traheal Stent Insertion

Position of the Tube

A
  • Ensure correct positioning of tube. A medical professional with experience inserting stents should assess for proper positioning and placement.
  • For Montgomery® tracheal stents, the correct placement is:
    • The space within the C shaped rings should be directed towards the patient’s feet.
    • The tube size number is directed towards the head; this number may not be visible if the tube has been trimmed.
    • There should be a patent channel through the tube to the anterior trachea.
31
Q

Policy- Traheal Stent Insertion

Assess Ventilatory Status

A

Occlude the opening and assess patient’s ventilatory status through the upper airway.

32
Q

Policy- Trach Weaning

Weaning Device

A

Speaking valve to fit the type of artificial airway in place

Note: Speaking valves are to be replaced per manufacturer instructions

Cork to fit the type of artificial airway in place
Note: Corks are to be replaced per manufacturer instructions

33
Q

Policy- Trach Weaning

Corking

A

Perform a complete respiratory assessment.

Encourage patient to clear secretions by deep breathing and coughing. Suction, if indicated.

Set up appropriate oxygen device as required.

Position patient in an upright position unless contraindicated.

Ensure the cuff is fully deflated, if present, and occlude the tracheostomy tube or stent with gloved finger, and observe to ensure patient can easily breathe around the tube.

Cork the tracheostomy tube.

34
Q

Policy- Trach Weaning

Assess Adequacy of Ventilation and Oxygenation

A

Note: Some patients may require instruction and reassurance during initial corking trials.

Note: Provide instruction on how to remove the cork in case of difficulty to the nurse and, if able, the patient.

35
Q

Policy- Trach Weaning

First Corking Trial

A

A patient performing their first corking trial is to be re-assessed within 1 hour.

36
Q

Policy- Trach Weaning

Consider Trach Decannulation

A

Consider tracheostomy decannulation when the patient can tolerate having their tracheostomy corked for 24 hours with minimal need for suctioning.

37
Q

Policy- Trach Weaning

Tracheostomy and Tracheal Stent: Speaking Valve

A

Deflate cuff if present, occlude tracheostomy tube with gloved finger, and observe to ensure patient can easily breathe around the tube.

Note: If the warning sticker is unavailable, label the cuff inflation line with: “Warning cuff must be completely deflated while wearing a speaking valve.”Affix manufacturer provided warning sticker to cuff inflation line.

Attach one-way speaking valve to the tracheostomy tube. Evaluate patient response.

38
Q

Policy- Trach Weaning

Tracheostomy and Tracheal Stent: Speaking Valve

If the Patient Cannot Breath Around The Tube

A

If the patient cannot breathe around the tube, consider changing to a cuffless and / or smaller outer diameter tube prior to one-way speaking valve trial.

39
Q

Policy- Trach Weaning

Tracheostomy and Tracheal Stent: Schedule Speaking Valve

A

Establish a schedule for use of one-way speaking valve, incorporate it in the individual care plan, and communicate with the healthcare team.

Note: Posting the plan in patient’s room is suggested.

40
Q

Policy- Trach Weaning

Safety Preautions

A

Cuffs must always be fully deflated.

Call bell must be within reach or the patient must be located so that they are visible to nursing staff at all times.

41
Q

Policy Trach Tube Change

Equitment

A

Personal protective equipment (PPE)

Emergency Artificial Airway Kit

Tracheostomy dressing tray

Drain sponge

Normal Saline

Suction supplies

Flexible suction catheter

Tracheostomy tube for insertion

Tracheostomy securement device

Syringe, 10 mL

Water soluble lubricant

Scissors and / or suture removal kit

Pulse oximeter

End Tidal CO2 detection device

42
Q

Policy Trach Tube Change

Equitment

End Tidal CO2 detection device

A

A device capable of capnography is the preferred choice however when unavailable, other End Tidal CO2 detection device such as colorimetric devices may be used.

43
Q

Policy Trach Tube Change

Enteral Feeds

A

Request PHCP hold enteral feeds for procedure to minimize aspiration risk.

44
Q

Policy Trach Tube Change

Before the Change

A

Pre-oxygenate

Ask patient to cough. If unable to clear secretions, suction tracheostomy and mouth as indicated.

Optimize patient position for procedure.

Note: The preferred position is supine with the head slightly extended.

45
Q

Policy Trach Tube Change

Sterile

A

Don sterile gloves.

Prepare tracheostomy tube for insertion while maintaining the sterility of the tracheostomy tube and tray. Inspect the functionality of the cuff (if present) and inner cannula.

Insert obturator and lubricate with water soluble lubricant.

46
Q

Policy Trach Tube Change

Stoma Site

A

If possible, inspect and clean the stoma. Instruct the patient to breathe easily while the stoma site is being cleaned.

Note: Prior to inserting the new tube, when tolerated, an upper airway assessment should be completed to assess for airway patency by temporarily occluding the stoma.

47
Q

Policy Trach Tube Change

Inserting New Tube

A

Insert the new tube on inspiration maintaining the sterility of the tracheostomy tube. The tube should be inserted at a 90-degree angle then rotated downward as the tube is advanced following the curvature of the tube.

Remove obturator, insert and secure the inner cannula.

Note: Refer to the Tracheostomy Adult Patient: Emergency Interventions Technical Support Document for the management of difficult and or unexpected events.

48
Q

Policy Trach Tube Change

Confirm Placement

A

Confirm placement of tracheostomy tube using at least one of the following methods:

Passing a suction catheter beyond the length of the tube with no resistance

End Tidal CO2 detection

49
Q

Policy Trach Care

Equitment

A

Personal protective equipment (PPE)

Tracheostomy dressing tray

Drain sponge

Normal Saline

Spare Inner cannula as required

Suction supplies

Additional equipment as required

Pressure manometer

Syringe, 10 mL

Hydrogen Peroxide, 3%

50
Q

Policy Trach Care

Cuff Management

A

Prior to any cuff manipulation, the patient’s upper airway and tracheostomy should be assessed for secretions and suctioned, if necessary.

If the cuff is to remain inflated, measure and set the cuff pressure.

Note: When possible, the use of a pressure manometer is preferred over minimal occlusion volume.

Assess cough and tracheostomy tube patency by encouraging patient to cough or by suctioning patient as necessary.

51
Q

Policy Trach Care

Trach Care

A

Position patient supine, if tolerated. Remove tracheostomy mask, ensuring the flow of oxygen continues to be directed at the tracheostomy.

Remove old dressing and discard.

Remove inner cannula, clean or replace as per manufacturer recommendations.

Note: Hydrogen peroxide half strength with normal saline may be used to clean re-useable inner cannulae only or per manufacturer’s instructions. Rinse thoroughly with normal saline prior to insertion.

Clean around the stoma with normal saline soaked gauze / cotton tipped applicator using a four quadrant approach, beginning at the midline and wiping away from the tracheostomy tube. Discard gauze/cotton tipped applicator after one pass.

Note: If crusting occurs at the stoma, apply saline-soaked gauze for a few minutes. Crusting around the stoma may be best managed by increasing the frequency of stoma care and by improving patient hydration and / or increasing delivered humidity.

Inspect skin around the stoma for signs of breakdown, bleeding and/or infection. If concerns are present, consider a specialized dressing and inform the most responsible health practitioner. (see references for AHS wound care guidelines)

Dry the site thoroughly.

52
Q

Policy Trach Care

Trach Care-After 24 Hours

A

After 24 hours, tracheostomy ties are changed only when visibly soiled.

(i) Note: Ties must allow for a total of two fingers between the tie and the side of the patient’s neck.

53
Q

Policy Trach Care

Trach Care-Applying Dressinf

A

Apply single tracheostomy dressing.

Note: Multiple layers of dressings can result in displacement of the tracheal tube. A dressing may not be necessary for patients with long- term tracheotomies.

Tracheostomies with sutured flanges where the dressing cannot easily slide into place may not have a dressing. Dressings are not to be placed over top of the flange.

CBRC (20 decks)

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