swallowing disorders: tracheostomy tubes part 1 Flashcards
types of respiratory problems: COPD (can’t get air out)
asthma
cystic fibrosis
chronic bronchitis
types of respiratory problems: restrictive (can’t get air in)
pneumonia
neuromuscular
3 functions of artificial airways
keep airway open (patency)
remove of secretions
facilitate mechanical ventilation
types of endotracheal tubes
nasotracheal intubation
orotracheal intubation
tracheostomy
*pros of orotracheal intubation
more common
less traumatic
larger diameter tube
placement is temporary
*cons of orotracheal intubation
discomfort and gagging
accidental extubation
oral hygiene is difficult
PO nutrition is impossible
*pros of nasotracheal intubation
more comfortable
oral hygiene can be done
smaller diameter tube
better tube stability
*cons of nasotracheal intubation
less common more complications increased airway resistance sinusitis otitis media
subclinical problems of intubation: VF damage: 3 results
granulomas
contact ulcers
laryngeal webs: scar tissue
anoxia hypoxia respiratory failure intubation extubation tracheostomy/tracheotomy tracheotomee
complete lack of oxygen reduction in oxygen exchange of O2/CO2 inadequate placement of endotracheal tube removal of endotracheal tube hole in trachea, usually to insert endotracheal tube actual patient with trach tube
3 reasons why tracheotomy tubes are placed
upper airway obstruction at/above level of VFs
potential upper airway obstruction
provide respiratory care
placement of trach tube
generally inserted into trachea through surgical incision through 3rd or 4th tracheal rings
placed well below VF’s to avoid damage to larynx
if emergency, may be placed at 2nd tracheal ring and cause scarring
left in place until airway obstruction is past and respiratory care is completed
occasionally, may remain permanently
pros of trach tubes
decreased resistance efficient secretion removal minimizes damage to larynx, VF's oral nutrition is possible more comfortable
cons of trach tubes
hemorrhage thyroid injury injury to laryngeal nerves air leaks cardiac arrest
*physiological changes to trach tubes
phonation secretions no valsalva maneuver increased airflow resistance bathing/showering swallowing psychological changes
3 trach tube parts
outer cannula
inner cannula
obturator
cuffed vs. uncuffed
cuff surrounds the lower portion of trach tube like a balloon
cuffed trach used when there is need for respiratory treatment or potential for patient to aspirate material
if deflate cuff, it is same as uncuffed trach- allows air to pass upward (to VF then can voice)
what is first thing as SLPs we should do?
DEFLATE THE CUFF
once the cuff is deflated….
look to see if pt can voice. finger clude the trach/tube (but not for long as they can’t breathe). if can’t achieve voicing, they’re not ready for voicing. once pt can voice, put passy muir valve- one way speaking valve- does not allow air out so air goes through VF’s (for voice). need to watch O2 sats.
passy muir valve: only when someone is in the room because if they fall asleep, run risk of sleep apnea, etc.
cuffed trachs, when deflate cuff, do what?
suction
cuffed trachs
fully inflated cuffs are usually not left in place for long periods of time due to the pressure of the cuff contacting the tracheal wall which can cause irritation. this may cause ischemia and lead to stenosis.
to prevent the above, may fully inflate then take 1-2 cc of air out of the cuff so some leak and decreased pressure on tracheal wall.
sometimes, fully inflated cuffs will still allow air leakage and aspiration due to ill-fitting tubes &/or tracheal wall deviations
