trach care: lab

Question 1

short term trach

Answer 1

o Trauma
o Burns
o Foreign body obstruction
o Severe anaphylaxis
o Infection such as epiglottitis or croup
o Tracheomalacia

Question 2

you always need by bedside

Answer 2

o Obturator
o Suction
o Oxygen
o Extra trach of same size and 1 size smaller

Question 3

long term trach

Answer 3

o Chronic lung conditions (BPD), long term oxygen therapy
o Tumors such as cystic hygroma (congenital mass in neck)
o Subglottic stenosis
o Syndromes such as Treacher Collins (chromosomal defect that affects the head and neck causing
craniofacial abnormalities)
o Neuromuscular disease that paralyzes respiratory muscles
o Fracture of cervical vertebrae with spinal cord injury

Question 4

Need for suction if:

Answer 4

▪ Rattling mucous sounds from the trach
▪ Increased respiratory rate
▪ Visible mucous in trach
▪ Dry raspy breathing or whistling noise from trach
▪ Signs of respiratory distress: increased heart rate, increased RR, increased BP, cyanosis
(severe)

Question 5

vacuum pressure

Answer 5

o 40-60mmHg for preemies
o 60mmHg for infants
o 80-100 mmHg for larger children

Question 6

3 types of suction:

Answer 6

▪ Shallow: just beyond the opening hub of the trach, if visible secretions
▪ Pre-measured suctioning: suctioning the length of the obturator is
recommended for all routine suctioning according to the American Thoracic
Society.
▪ Deep suctioning: suctioning until resistance is met, then pull back
• This has been the practice for some time for nurses, but research has
proven that it can cause tracheal damage, so reserve deep suctioning
only for emergencies or if advised to do so by the physician

Question 7

passes

Answer 7

No more than 3 passes recommended per treatment. Let child rest for 30-60 seconds
between suctions.

Question 8

Indications for changing trach include:

Answer 8

• buildup of mucous or secretions
• obstruction of tube
• dirty or soiled tube
• size no longer appropriate for patient,
• or at least every 29 days (for Shileys)