swallowing disorders: tracheostomy tubes part 1

Question 1

types of respiratory problems: COPD (can’t get air out)

Answer 1

asthma
cystic fibrosis
chronic bronchitis

Question 2

types of respiratory problems: restrictive (can’t get air in)

Answer 2

pneumonia

neuromuscular

Question 3

3 functions of artificial airways

Answer 3

keep airway open (patency)
remove of secretions
facilitate mechanical ventilation

Question 4

types of endotracheal tubes

Answer 4

nasotracheal intubation
orotracheal intubation
tracheostomy

Question 5

*pros of orotracheal intubation

Answer 5

more common
less traumatic
larger diameter tube
placement is temporary

Question 6

*cons of orotracheal intubation

Answer 6

discomfort and gagging
accidental extubation
oral hygiene is difficult
PO nutrition is impossible

Question 7

*pros of nasotracheal intubation

Answer 7

more comfortable
oral hygiene can be done
smaller diameter tube
better tube stability

Question 8

*cons of nasotracheal intubation

Answer 8

less common
more complications
increased airway resistance
sinusitis
otitis media

Question 9

subclinical problems of intubation: VF damage: 3 results

Answer 9

granulomas
contact ulcers
laryngeal webs: scar tissue

Question 10

anoxia
hypoxia
respiratory failure
intubation
extubation
tracheostomy/tracheotomy
tracheotomee

Answer 10

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

Question 11

3 reasons why tracheotomy tubes are placed

Answer 11

upper airway obstruction at/above level of VFs
potential upper airway obstruction
provide respiratory care

Question 12

placement of trach tube

Answer 12

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

Question 13

pros of trach tubes

Answer 13

decreased resistance
efficient secretion removal
minimizes damage to larynx, VF's
oral nutrition is possible
more comfortable

Question 14

cons of trach tubes

Answer 14

hemorrhage
thyroid injury
injury to laryngeal nerves
air leaks
cardiac arrest

Question 15

*physiological changes to trach tubes

Answer 15

phonation
secretions
no valsalva maneuver
increased airflow resistance
bathing/showering
swallowing
psychological changes

Question 16

3 trach tube parts

Answer 16

outer cannula
inner cannula
obturator

Question 17

cuffed vs. uncuffed

Answer 17

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)

Question 18

what is first thing as SLPs we should do?

Answer 18

DEFLATE THE CUFF

Question 19

once the cuff is deflated….

Answer 19

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.

Question 20

cuffed trachs, when deflate cuff, do what?

Answer 20

suction

Question 21

cuffed trachs

Answer 21

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