SL1 - Emergency Surgical Procedures and Feeding Tubes Flashcards
when is a temporary tracheostomy used
Tx of upper airway obstruction that is expected to resolve with appropriate Tx
for use with patients undergoing mechanical ventilation (prevents pressure necrosis and oral lesions secondary to ET intubation)
how big should the tracheostomy tube be
~ 1/2 the diameter of the trachea
sizes do not correspond to ET tubes
when are cuffed tracheostomy tubes needed
mechanical ventilation
where is the incision made for temporary tracheostomy
ventral midline
caudal edge of the cricoid, 4-5 cm in length
dissect between strap muscles
transverse interannular incision - typically between 3rd and 4th or 4th and 5th rings (no more than 50% of trachea)
nursing care after temporary tracheostomy
intensive, experience nursing care
nebulize 20 min → pre-oxygenate for 3-5 min → suction trachea - to level of carnia (< 10 sec) repeat 2-4x→ admin 100% O2 for 3-5 min → clean and replace inner cannula → clean skin around incision → replace tube q 24hrs
complications of temporary tracheostomy
tube occlsion
pneumomedastinum
surgical site infection
coughing/gagging/vomitting
aspiration pneumonia
vagally mediated bradycardia and collapse
why should temporary tracheostomy be allowed to heal by second intention
suturing site will result in SQ emphysema that can progress to pneumomediastinum or pneumothorax
when are thoracostomy tubes used
treatment of pleural space disease and for continued post-operative drainage
pneumothorax, pyothorax, hemothorax, other pleural effusions
how wide shoud the thoracostomy tube be
less than or equal to the width of the intercostal space
length of thoractomy tube
pre-measure!!!
start point: dorsal 1/3rd of thoracic wall at 7-9 IC space
end point: ~ point of elbow
where should incision be placed (thoracostomy tube)
2-3 rib spaces caudal to desired intercostal entry point
what is required to confirm placement and advancement of thoracostomy tube
radiographs
T/F tubes can be repositioned for minor changes
true
rescrub, wear sterile gloves, tubes can be backed out but not inserted further into thorax
handling of thoracostomy tube
ensure system is closed
wear gloves when handling
cover exit site with bandage
evaluate exit site daily for signs of infection
when can thoracostomy tube be removed
air: absence of pneumothorax for 12-24 hours
fluid: production of less than or equal to 2 mls/kg/day
