Tracheostomies Flashcards
Tracheostomy
artifical airway
- temporary or permanent
indications for traches
- head and neck cancers
- subglottic stenosis
- neuromuscular disease (MS)
- spinal cord injuries
oral artificial airway
use
used to prevent tracheal obstruction caused by tongue displacement
oral artificial airway
components
measure from corner of mouth to earlobe and put in arch side down then twist 180
- channel is inside the piece for suctioning
Endotracheal airway
use
used to relieve and ventilate upper airway from an obstruction
- only for short term use
- “intubation” (GCS less than 8 time to intubate)
Endotracheal airway female sizing
7-7.5mm
Endotracheal airway sizing for men
8-9mm
Tracheostomy
use
used long term and is completed through surgery
tracheostomy sizing for women
10 mm
tracheostomy sizing for men
11 mm
indicastors for tracheostomy
4
- prolonged mechanical ventilation (day 10-14)
- upper airway obstruction
- upper airway surgeries (ENT)
- patient needs assistance monitoring long term
Shiley tracheostomy tube
characteristics
- long term
- can be cuffed or uncuffed
- inner canula for cleaning
- can be fenestrated which allows for plugging
- non-fenestrated inner canula must be in before suctioning
portex tracheostomy tube
characteristics
- short term (days to weeks)
- cuffed
- non fenestrated
- may have inner canula
cuffed vs un-cuffed tracheostomy
whether or not there is a filled balloon seperating the upper and lower airway
fenestration allows for…
patient to still breathe through airway
parts of shiley trach tube
- shaft (main tube)
- inner canula
- pilot balloon (where you insert air to inflate cuff)
obterator
used to insert trach
Flange
sits outside of trachea on surface of neck to keep tube from falling in
hypoxia resultung from tracheostomy
and interventions
occurs due to arterilal O2 lowering during suctioning
- prevent through hyperoxygenation prior to suctioning for at least 5 breaths
tissue trauma resulting from tracheostomy
and interventions
occurs due to over suctioning (will see blood tinged sputum)
- intervention is only suction when needed, making sure to draw back when resistance is felt, deflate cuff as needed
infection resulting from tracheostomy
and interventions
increased secretions, increased HR RR and temp, local infection around stoma; can be caused by cuff leaks
- follow asepsis to avoid, routine suctioning, provide oral care, ensure hydration and nutrition is adequate
bronchospasm resulting from tracheostomy
and interventions
caused by stimulation of lungs (hit where it breaks off between right and left main stem)
- prepare to use ventolin or atrovent
indications for suctioning
5
- secretions
- respiratory distress
- request
- aspiration
- need to obtain sample
open system for suctioning
sterile catheter and glove
high risk for infection and must wear full PPE
closed system for suctioning
In-line catheter
decreases chance of environmental contamination
suctioning basics
pressure, how to do it, duration, time between, passes allowed
- sterile
- pressure of 120-150
- pass until resistance is felt then pull back a bit
- no longer than 10-15 sec
- allow 5 breaths in between
- only 2 passes
aspiration
potential complicatiomn of suctioning
elevate HOB to 30-45, NPO, swallow assessment, monitor for abdominal distention
assessment
sputum
trend changes and monitor for infection (amount, color, thickness)
- auscultate lungs, check labs (WBC), temp,
unexpected is green, yellow, thick brown
cuff leak
complication of trach/suctioning
can cause aspiration and inadequate seal can lead to infection
- check if intact and inflated
bleeding through and around stoma
complication of trach/suctioning
apply O2 and pressure, call physician, inspect stoma
safety for bedside
before suctioning
bagger and mask, 10cc syringe, OPA, full O2 cylinder, sterile catheter and yankeur
site care of trach
assessment timing and tie change timing
- care is done q12 hours (inner canula and dressing change)
- tie changes done q24 hours (make sure you can fit 2 fingers or 4-5 cm)
clean around stoma, assess for skim breakdown
psychosocial considerations
- yes and no questions
- involve patient
- explain who you are
