Trach Care Flashcards
How should one measure for sizing an oropharyngeal airway?
Measure (quick if an emergency) – base it also on age and size of person. Put flange parallel to teeth and the curved part next to the cheek – tip should be at the angle of the jaw.
What size of oropharyngeal airway do babies and small children use?
000 to 3
What size of oropharyngeal airway do bigger children normally wear?
3 to 4
What size of oropharyngeal airway do adults usually wear?
4 and over
Who should not have a nasopharyngeal airway inserted?
Patients with facial trauma.
What is the purpose of oral airway suctioning?
Removes secretions from the mouth (will also remove O2)
What is oropharyngeal suctioning?
Inserted through the mouth to the pharynx
What is nasopharyngeal suctioning?
Inserted via nares to pharynx.
What are some complications of airway suctioning?
Complications – (negative aspects) disruptive to mucous membranes Damage mucous membranes Uncomfortable Bradycardia Hypoxic patients can become tachycardic Increased potential for infection Laryngeal spasm
What are some anatomical features of the trachea?
The trachea is the first part of the airway not shared by GI tract
Trachea stretches between the larynx and the carina
In the average adult it is 10-12cm long and 2.5cm in diameter
The trachea is protected by 16-20 hyaline cartilage rings which help to maintain patency
How is the placement of a tracheostomy checked?
X-ray
Are tracheostomies temporary or permanent?
Can be temporary or permanent.
What is the purpose of a tracheostomy tube?
The tube keeps the stoma open. It shortens the length of the upper airway, and decreases the work of breathing for the patient.
What is a tracheostomy?
An artificial opening (or stoma) in the trachea
Where is a tracheostomy created?
Surgically created between 2nd and 3rd cartilaginous ring
What are some indications for tracheostomy?
Upper airway obstruction Upper airway bleeding Trauma/burns Prolonged artificial ventilation Respiratory insufficiency Inability to clear secretions effectively Inability to protect own airway
What are some complications of tracheostomy?
Airway occlusion Tissue damage (necrosis, ulceration) Infection Communication difficulties Tube displacement/dislodgement Bleeding Tracheo-oesophageal fistula Inability to maintain nutrition/hydration needs Air leaks Loss of normal airway function Decreased sense of smell/taste Decreased nutritional intake (as a result of decreased smell/taste)
What are tracheostomy tubes made of?
Silicone.
What are some variations in the designs of tracheostomy tubes?
Vary in length, size, composition and number of parts. Can also be cuffed or uncuffed, fenestrated or non fenestrated.
What is the purpose of a fenestrated tracheostomy tube?
Fenestrated = has holes in it. Fenestrated ones allow air to go up and out of the airway, as well as breathe through the trach tube. This can help them to have a little bit of a voice.
What is the purpose of a cuffed tracheostomy tube?
Cuff is to occlude the airway to reduce the risk of aspiration.
What kind of patients would require a cuffed tracheostomy tube?
Patients on a ventilator.
What are the three components of a tracheostomy tube?
Outer cannula (cuffed/uncuffed)
Inner cannula
Obturator
What is an attachment for tracheostomy tubes that are optional?
May have speaking valves attached (these are expensive, $300-$400)
What are some nursing implications for caring for patients with a trach tube?
Preparation Patient assessment Patient education Communication/body image Procedures Emergencies Guidelines and documentation
What should the nurse do to prepare for trach care?
Equipment at bedside Patient assessment Procedures discussed with patient Patient in correct position 2nd nurse identified to help (if necessary) with procedures
What are some important aspects of patient assessment when performing trach care?
Why does the patient have a tracheostomy? How long have they had a tracheostomy? Type/size of tube Level of respiratory support needed Respirations/breath sounds Cuffed?/inflated? Humidification method? Suction required?/how often? Thickness, colour, amount of sputum Cleaning of inner tube? Wound assessment/dressing changes Can the patient swallow? Assessment done? Weaning progress When does the outer tube need changing? What does the patient look like? Patient education Mouth care
What are some important aspects f patient education for patients with tracheostomy?
Explain all procedures Pre-op education Communication limitations/alternatives Involve family Utilize other experts as appropriate
What is the reason that humidification is required for a patient with a tracheostomy tube?
Humidification occurs in the upper airway. When a tracheostomy is formed, the upper airway is bypassed. Humidification warms and moistens the air.
What are some possible complications of humidification for a trach patient?
Potential for fluid build-up in corrugated tubing
Insufficient/excessive humidification
How often should the inner cannula of a tracheostomy be changed?
Once per shift and PRN
What are some dressing and cannula change basic principles?
Preparation Asceptic/clean technique Patient education Wound assessment Documentation
Is a tracheosomy inner cannula change a clean procedure or a sterile procedure?
Clean
What procedures regarding trach care need to be sterile?
Caring for a new tracheostomy (first 5-7 days)
Suctioning a tracheostomy
What are some indications for suctioning tracheostomy?
Visible or audible secretions Suspected aspiration Dropping peripheral O2 sats Increased coughing Reduced airflow
What are some adverse affects of suctioning?
Hypoxia
Trauma
Infection
As necessary
What are some measures the nurse can take in order to prevent hypoxia when suctioning a tracheostomy?
Might need to pre-oxygenate them a little bit. If they aren’t on continuous oxygen, we can get them to take some big deep breaths to get a bit more oxygen into them before they are suctioned. When we suction, three passes and then done. If you can’t get the secretions out with 3 passes, you need to wait a bit before trying it again. Should only have the suction in there for 10-15 seconds at a time.
What are some measures the nurse can take in order to prevent trauma when suctioning a tracheostomy?
- Apply suction on the way out, not the way in. As you introduce the suction catheter into the tube, they will start coughing. When they cough, pull it out a bit and then start the suction. If you suction on the way in, you can accidentally suction the mucous membranes and cause trauma to the tissues.
What emergency equipment should you have available for a patient with a tracheostomy?
Suction machine (on the wall)
Suction catheters
If they have inline suction, make sure they have a spare one of those
If not in-line suction, make sure they have 2 or 3 extra
We need a whole tracheostomy unit that is the same size as the one the patient is wearing, as well as one that is one size smaller.
The oxygen on the wall should be working.
Make sure you have 2 or 3 spare inner cannulas.
We should have a dilator (these are foreceps that if you squeeze it, it opens). If it is a relatively new tracheostomy and the tube falls out, these will be necessary to keep it open. If it is well-established, we shouldn’t need these. But they are necessary to have in case of emergency.
Velcro
10mL syringe (to deflate the cuff in an emergency). If we don’t have one, make sure you have scissors and you can just cut it and the cuff will deflate.
Mask
Eye proception
Gloves
Bag
