trach Flashcards
post op care trach
ensure patent airway, confirm bilateral breath sounds, resp assessment hourly, assess for complications
tube dislodgement and accidental decannulation- first 72 hrs
emenrgency first 72 hrs, vent w manual resuscitation rapid response, keep tube of same type and size at bedside
tube dislodgement and accidental decannulation- after 72 hrs
open stoma and replace tube, then remove obturator, check for airflow through tube and bilateral breath sounds
tube obstruction- indicators-5
secretions or cuff displacement-
indicators- difficulty breathing, noisy resp, difficulty inserting suction catheter, thick/dry secretions, unexplained peak pressures
pneumothorax
air in chest cavity- X ray chest
subcutaneous emphysema
- opening or tear in trach and air escapes into neck tissue
- inspect and palpate for air under skin
- notify HCP immediately
bleeding
- constant oozing is abnormal
- wrap gauze around tube and pack gauze gently into wound to apply pressure
infection
sterile technique
- assess stoma q 8 hrs for purulent drainage/ redness/ pain/ swelling
- do not cut dressings, change often
tracheomalacia
constant pressure exerted by the cuff causes tracheal dilation and erosion of the cartilage
tracheomalacia prevention-2
- use uncuffed tube asap
2. monitor cuff pressure and air vol closely and detect changes
tracheal stenosis
narrowed trachael lumen is due to scar formation from irritation of trachael mucosa by the cuff
tracheal stenosis manifestations-3 +mgt
- usually seen after cuff deflated or trach removed
- increased coughing w inability to expectorate secretions
- difficulty breathing or talking
mgt- trach dilation or surgical intervention
tracheal stenosis prevention-4
- prevent pulling/traction on tube
- properly secure in middle position
- maintain proper cuff pressure
- minimize oronasal intubation time
tracheoesophageal fistula (TEF)
excessive cuff pressure causes erosion of the post wall- a hole is created between trachea and anterior esophagus
- pt at highest risk also has NG tube
tracheoesophageal fistula manifestations-4
- food in secretions
- increase air needed for seal
- increase choking and coughing while eating
- does not receive set tidal vol on vent
tracheoesophageal fistula (TEF) mgt-3
- manually administer O2 by mask
- use small soft feeding tube instead of NG tube
- mon pt w ng tube closely-assess for TEF and aspiration
tracheoesophageal fistula (TEF) prevention-3
- maintain cuff pressure
- mon amt of air needed for inflation for changes
- progress to deflated cuff or cuffless tube asap
trachea-innominate artery fistula
a malpositioned tube casues distal tip to push against the lateral wall, cont pressure causes necrosis and erosion of the innominate artery
*emergency
trachea-innominate artery fistula manifestations-3
- trach tube pulsates in synch w heart beat
- heavy bleeding from stoma
- life-threatening
trachea-innominate artery fistula mgt-3
- remove trach tube immediately
- apply direct pressure to innominate art at stoma site
- prepare for emergent surgery
trachea-innominate artery fistula prevention-3
- correct tube size, length, and midline position
- prevent pulling or tugging on tube
- immediately notify HCP
cuffed tubes
vented w no protection from aspiration
noncuffed tube
not vented
reusable inner cannula
inspect/suction/clean as often as needed in first 24 hrs
fenestrated tube-3
can open and close
- do not cap if any problems present
- may be cuffed or uncuffed
preventing tissue damage-5
- always deflate cuff before capping
- keep pressure between 14-20 mmHg or 20-30 cm H2O-check at least 1 q shift
- use least amt of pressure to form seal
- maintain proper pressure/stabilize tube
- prevent malnutrition/dehydration/ and hypoxia
ensuring air warming and humidification-4
- humidify as prescribed
- assess for fine mist
- increase flow rate at the floemeter to increase humidity
- keep temp between 98.6-100.4
prevent infection-3
sterile technique, suction mouth/nose after trach, never use oral suctioning equipment for suctioning art airway
weaning
cuff deflated after pt can manage secretions and does not need vent- changed to uncuffed tube- size gradually decreased- can be removed after 24 hrs of capping
prevent aspiration-9
not when fatigued, thick liquids, avoid fruit, position as upright as possible, deflate tube, suction after deflation and before meal, dry swallow, spoon liquids
tube obstruction-prevention-4*
- prevention- cough and deep breathe, inner cannula care, humidify O2, suctioning
- HCP repositions or replaces tube
tracheomalacia-indications-4, mgt
- indications- increase air needed for seal, larger tube needed to prevent leak, food in secretions, pt does not receive set tidal vol.
- mgt- nothing unless bleeding
