Mod 4 Tracheostomy Flashcards
why are some tracheostomy inscisions horizontal (the preferred) over vertical?
It heals better if you don’t cut the rings.
Where would a emergency trach be done?
between the crycoid and the thyroid
Percutaneous trachestomy is basically what technique (in terms of similarities)
seldinger technique
-uses a needle over wire and dilators to insert tube between the tracheal rings.
why are percutaneous trachestomys prefered emergency incision trac?
They heal faster w/ the percutaneous trach.
What are some contrainments/issues with tracheotomy’s?
bleeding disorders are a issue.
The need absolute need for a emergent airway is more important than uncontrolled bleeding.
what is the most important and difficult problem with trachs.?
Landmarking
what is a fenustration air cannula?
Where the actual incision is for airways.
what are some of the seals functions of a cuffed trach tube?
protects airway; preventing/minimize aspiration.
It is a closed system that is required to ensure proper airway to lungs and prevent air from escaping upward around the tube.
Why can’t you speak when you a person with a trach tube is corked?
The vocal cords are above the cuff of the trach tube preventing airway leaks or access through the top.
Only time it will be uncuffed/inflated if there is risk of aspiration or need to move to ventilators.
What factor do you want to be unfenustrated? why?
The inner cannula is the main tube you want to make sure is not fenustrated
fenustrated tubes in an inner cannula would make guidance difficult.
fenustrated vs unfenustrated tubes for tracheotomy’s?
Edit
For transport, how do they keep pressure in the cuff?
saline
foam cuff; foam is injected instead of air
Trach care: clean procedure (procedure is longer than 72 hrs)?
what is equipment you could expect to be in it (or added)?
PPE
sterile gloves
suction, O2, and BVM
Trach care kit (gauze, brushes, tweezer, q tips)
hydrogen peroxide and sterile water (or saline)
new drain sponge
new trach tube ties or holder
Trach safety equipment
optirater (introducer) - basically a stylet or pen to smooth out the outer cannula. replace with inner cannula.
spare inner cannula (and one size smaller)
trach bag includes:
same size trach (and 1 down).
scissors (to cut ties)
syringe (deflate cuff)
lubricant
ties
Trach care indications
every time you visit the patient.
Reduce stoma irrational
maintain patency
dressing change q24h
ties changed prs
inner cannula assessed 4hs and prn
Trach care
avoid during first 24 hrs
store inner cannula at bedside in clean dry container
soaking of area around stoma may be necessary.
make sure to hold the airway so it doesn’t fall out; an extra body helps.
why trach airways increase incidence of pulmonary infection
higher risk of infection (opening w/blood and stuff)
bypassed the upper airway
patient cannot clear airways on their own (ineffective cough)
Trach changes
remember to put optirator back in when reinserting; change may be done bc the switching trach sizes, decannulate, or switch to non fenustrated or uncuffed.
complications during trach = increased risk
not before 7 days
what is a indicator a trach tube should be changed
can’t pull the suction cather
Post trach procedure complications
bleeding
excessive bleeding
excessive coughing
airway obstruction
aspiration
subcutaneous emphysema
What is a unlisted intervention for a aspiration event?
increasing nutrition status to prevent stomach acids from increasing
1.The main would be to move patients position (side or sitting)
2. suction airway
3.inflate the cuff on the tube if present
4. encourage deep coughing to clear secretions
contents of the trach change emergency kit
(#6 size kit)?
(insert image from slide 27)
Why would a patient have a cuffed trach tube?
Minimize risk of aspiration
mechanical ventilation; ensures adequate airflow
When are uncuffed tracheostomy tubes suitable for patients?
Awake and alert, not a risk for aspiration
can protect their own airway
Do not require mechanical ventilation
How often should tracheostomy tubes be changed?
edit compare to test answer
Regular basis (could be daily? -> need to confirm)
changes within 3 months of the last tube.
