Tracheostomy Flashcards
What is a tracheostomy?
Temporary stoma created in the trachea
What is the name given to a permenant trachestomy? what do you need to remember?
Laryngectomy
No patent upper airway
Obligate neck breathers
4 reasons for a trachestomy?
bypass airway obstruction
Patients with neuromuscular conditions
Suction secretions
Wean from ventilatory support / ICU
Who has provided guidance for management of adult patients with trachestomys?
National Tracheostomy Safety Project
What is the difference in the red sign and the green sign above someones bed?
Red = post laryngectomy, obligate neck breathers, cant be ventilated via nose and mouth Green = post tracheostomy, can be ventilated through nose and mouth if needed
2 methods of tracheostomy insertion? who performs them?
percutaneous dilatation - ICU expert intensivist or anaesthetist
Surgical insertion by ENT surgeon in theatre, larger wound
When is insertion of tracheostomy most likely to suffer issues?
in 5 days post insertion
often shrinks a lot
Difference between a single and dual cannula tracheostomy?
Single has no inner cannula
Dual has an inner cannula which can be removed for cleaning mucus and secretions
Why does a cuffed tracheostomy effect the management of a blocked tracheostomy and a bleeding tracheostomy?
Blocked - deflating cuff allows more air to get passed, more time before expert team arrive
Bleeding - need to ensure cuff is fully inflated as could be acting as tamponade
What does a cuffless tracheostomy allow the patient to do but what does it also put the patient at risk of?
Allows the patient to speak and cough but leaves them at risk of aspiration
How is a speaking valve used on a tracheostomy? what does it do? risks? In emergency?
A one valve attached to the end of a tracheostomy that allows air to enter through tracheostomy tube and exit through mouth and nose
Risk of airway obstruction
Can only be used with uncuffed or deflated cuffed
In emergency all valves and caps must be removed
What are the 4 main basic points involved in tracheostomy care?
Daily checks
How to suction
Importance of humidification
How to clean or change inner cannula
How do you manage a tracheostomy emergency?
Apply Oxygen to both face and tracheostomy
Remove stoma cap, any speaking valves and inner cannula
Suction and see for patency
If not patent, deflate cuff
If still not improving, remove tube
If apnoeic then ventilate via upper airway and cover stoma
How do you manage a laryngectomy emergency?
Apply Oxygen to the trachestomy and not the upper airways
Remove any caps, speaking valves or inner cannulas
Suction to check patency
If not patent then deflate cuff
if still not improving then remove tube and ventilate from the laryngectomy stoma not upper airways
What can you ask the patient initially to assess if there is any obstruction in the tracheostomy?
Ask them to cough