Tracheostomized Related Swallowing Disorders Flashcards
Surgical procedure performed when oral/nasal breathing is not adequate and produces respiratory distress
Tracheostomy
What are the indications for tracheostomy?
- upper airway obstruction
- disruption of normal air exchange into/out of the lungs
- prolonged intubation
- need for long-term mechanical ventilation
- need for permanent teach tube
What is the purpose of articial airway?
- elimination of airway obstruction
- ventilation and oxygenation
- connect to mechanical ventilation
- provide access to lungs for pulmonary toilet
Nasotracheal vs orotracheal
- might damage to VFs
- Bad vocal quality or no voice
Where does a tracheostomy occur?
usually in 2nd to 4th tracheal ring
Cuff inflated vs cuff deflated
inflated: no air going through, no voice, no cough
deflated: get expiratory air for throat clearing/clearing airway
Fenestrated vs. non fenestrated
- providing extra expiratory air for throat clearing, coughing and voicing
- not used in individuals at high risk of aspiration
- fenestrated tube used as part of weaning process
What is the overall impact of tracheostomy?
- swallowing may or may not be affected by presence of trach.
- impaired smell and taste
- increased secretion
- disrupt of airway pressures
- trauma related to cuff
- may increase potential dysphagia
What is the impact on swallowing function of tracheostomy?
- potential for dysphagia is increased due to tracheostomy tube presence and surgical procedures
- changes of phsyiology of swallowing such as airflow pressure differences, reduced laryngeal sensitivity, reduced laryngeal excursion and all this may lead to aspiration
Normal laryngeal sensitivity =
cough
Decreased tongue base movement and propulsion, delayed trigger, reduced pharyngeal constriction, and UES not opening completely are all due to?
Reduced laryngeal excursion
The loss of expiratory airflow through the upper airway for normal respiration has been linked to…
increased pooling of secretions within the larynx and pharynx.
Trach is not associated with increased risk of aspiration and pneumonia. T or F?
False; it is.
delayed laryngeal vestibule closure which is associated w/aspiration
Priot to swallow assessment and feeding cuff must be at least partially _______ to identify potential aspiration.
deflated
full cull deflation is the goal
Can pts cough through larynx to clear laryngeal vestibule with cuff inflation?
No they cannot
What can repetitive swallow movements with an inflated cuff cause?
tracheosophageal fistula due to rubbing on tracheal wall
Assessing w/ deflated cuff allows….
pt to cough/clear throat and general airway protection abilities
IF assessing w/ inflated cuff only assess…
oral stage and ability to trigger swallow
Oral intake should be deferred until at least ________ is achieved.
partial cuff deflation
What should you do if physician desires pt do eat w/ fully inflated cuff?`
Explain and document limiations and damages of swallowing in presence of inflated cuff!
Before blue due test protocol…
- place pulse oximeter, deflate cuff partially or fully
- have pt suctioned as needed
- perform oral hygiene
- dry swallow
- oral mech exam
Blue Dye Test Protocol
- administer food/liquids as in reg. bedside eval.
- start w/ water colored blue
- check vocal quality and encourage throat clearing/cough
- look for blue secretions in suction catheter (positive finding)
- suction
- rest
- resuction
What do you do if blue dye test is positive/negative?
if positive: terminate test
if negative: allow further trials of test swallows
When full cuff deflation is not possible…
only a few exercises can be used to strengthen and prepare for swallow
Breath holding techniques will work with open trach. T or F?
False, they will not work.
Compensatory Techniques (6)
chin tuck head turn chin tuck and head turn effortful swallow double/multiple swallow clearing throat after swallow
