Tracheostomy Flashcards

1
Q

What is a tracheostomy?

A

Temporary stoma created in the trachea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the name given to a permenant trachestomy? what do you need to remember?

A

Laryngectomy
No patent upper airway
Obligate neck breathers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

4 reasons for a trachestomy?

A

bypass airway obstruction
Patients with neuromuscular conditions
Suction secretions
Wean from ventilatory support / ICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Who has provided guidance for management of adult patients with trachestomys?

A

National Tracheostomy Safety Project

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the difference in the red sign and the green sign above someones bed?

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 methods of tracheostomy insertion? who performs them?

A

percutaneous dilatation - ICU expert intensivist or anaesthetist
Surgical insertion by ENT surgeon in theatre, larger wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When is insertion of tracheostomy most likely to suffer issues?

A

in 5 days post insertion

often shrinks a lot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Difference between a single and dual cannula tracheostomy?

A

Single has no inner cannula

Dual has an inner cannula which can be removed for cleaning mucus and secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why does a cuffed tracheostomy effect the management of a blocked tracheostomy and a bleeding tracheostomy?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does a cuffless tracheostomy allow the patient to do but what does it also put the patient at risk of?

A

Allows the patient to speak and cough but leaves them at risk of aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is a speaking valve used on a tracheostomy? what does it do? risks? In emergency?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 4 main basic points involved in tracheostomy care?

A

Daily checks
How to suction
Importance of humidification
How to clean or change inner cannula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you manage a tracheostomy emergency?

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you manage a laryngectomy emergency?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What can you ask the patient initially to assess if there is any obstruction in the tracheostomy?

A

Ask them to cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If you have assessed patient, applied oxygen, removed caps and inner cannulas, deflated cuff, suctioned and they still don’t have a patent airway, what can you do?

A

Call anaesthetic team as an emergency

Ventilate the patient at either the tracheostomy stoma, mouth or both depending on which airways should be patent

17
Q

What types of oxygen delivery are used to ventilate a tracheostomy patient?

A

Use bag valve mask (Ambu) over stoma site

Then use LMA if you can

18
Q

What is a key part of tracheostomy managed to prevent secretion blockage?

A

Constant humidification of the airways

19
Q

How do you manage minor bleeding of a tracheostomy?

A

Pressure

Adrenaline soaked swabs until help arrives

20
Q

how do you manage major bleeding of a tracheostomy?

A

Need a surgeon to place artery forceps on bleeding vessel and transferred to theatre

21
Q

Who needs to be informed if a tracheostomy patient is experiencing surgical emphysema? what risk do they have of developing?

A

Need to inform anaesthetics and ICU

risk of developing pneumomediastinum

22
Q

5 complications can develop with a tracheostomy?

A
Blocked
Dislodged tracheostomy
Bleeding
Surgical emphysema
Pneumothorax
23
Q

How do you apply emergency oxygen to a laryngectomy stoma site?

A

LMA mask or paediatric face mask over the stoma

24
Q

How do you apply emergency oxygen to a tracheostomy patient?

A

Cover tracheostomy site with swabs or hand

Airway manoeuvres with bag valve mask, oral or nasal airway adjuncts, LMA