Mod 4 Tracheostomy

Question 1

why are some tracheostomy inscisions horizontal (the preferred) over vertical?

Answer 1

It heals better if you don’t cut the rings.

Question 2

Where would a emergency trach be done?

Answer 2

between the crycoid and the thyroid

Question 3

Percutaneous trachestomy is basically what technique (in terms of similarities)

Answer 3

seldinger technique
-uses a needle over wire and dilators to insert tube between the tracheal rings.

Question 4

why are percutaneous trachestomys prefered emergency incision trac?

Answer 4

They heal faster w/ the percutaneous trach.

Question 5

What are some contrainments/issues with tracheotomy’s?

Answer 5

bleeding disorders are a issue.

The need absolute need for a emergent airway is more important than uncontrolled bleeding.

Question 6

what is the most important and difficult problem with trachs.?

Answer 6

Landmarking

Question 7

what is a fenustration air cannula?

Answer 7

Where the actual incision is for airways.

Question 8

what are some of the seals functions of a cuffed trach tube?

Answer 8

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.

Question 9

Why can’t you speak when you a person with a trach tube is corked?

Answer 9

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.

Question 10

What factor do you want to be unfenustrated? why?

Answer 10

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.

Question 11

fenustrated vs unfenustrated tubes for tracheotomy’s?

Edit

Question 12

For transport, how do they keep pressure in the cuff?

Answer 12

saline

foam cuff; foam is injected instead of air

Question 13

Trach care: clean procedure (procedure is longer than 72 hrs)?

what is equipment you could expect to be in it (or added)?

Answer 13

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

Question 14

Trach safety equipment

Answer 14

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

Question 15

Trach care indications

Answer 15

every time you visit the patient.

Reduce stoma irrational
maintain patency
dressing change q24h
ties changed prs
inner cannula assessed 4hs and prn

Question 16

Trach care

Answer 16

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.

Question 17

why trach airways increase incidence of pulmonary infection

Answer 17

higher risk of infection (opening w/blood and stuff)

bypassed the upper airway

patient cannot clear airways on their own (ineffective cough)

Question 18

Trach changes

Answer 18

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

Question 19

what is a indicator a trach tube should be changed

Answer 19

can’t pull the suction cather

Question 20

Post trach procedure complications

Answer 20

bleeding
excessive bleeding
excessive coughing
airway obstruction
aspiration
subcutaneous emphysema

Question 21

What is a unlisted intervention for a aspiration event?

Answer 21

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

Question 22

contents of the trach change emergency kit
(#6 size kit)?

(insert image from slide 27)

Question 23

Why would a patient have a cuffed trach tube?

Answer 23

Minimize risk of aspiration

mechanical ventilation; ensures adequate airflow

Question 24

When are uncuffed tracheostomy tubes suitable for patients?

Answer 24

Awake and alert, not a risk for aspiration

can protect their own airway

Do not require mechanical ventilation

Question 25

How often should tracheostomy tubes be changed?

edit compare to test answer

Answer 25

Regular basis (could be daily? -> need to confirm)

changes within 3 months of the last tube.