Tracheostomy

Question 1

What is a tracheostomy?

Answer 1

Temporary stoma created in the trachea

Question 2

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

Answer 2

Laryngectomy
No patent upper airway
Obligate neck breathers

Question 3

4 reasons for a trachestomy?

Answer 3

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

Question 4

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

Answer 4

National Tracheostomy Safety Project

Question 5

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

Answer 5

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

Question 6

2 methods of tracheostomy insertion? who performs them?

Answer 6

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

Question 7

When is insertion of tracheostomy most likely to suffer issues?

Answer 7

in 5 days post insertion

often shrinks a lot

Question 8

Difference between a single and dual cannula tracheostomy?

Answer 8

Single has no inner cannula

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

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

Answer 11

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

Question 12

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

Answer 12

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

Question 13

How do you manage a tracheostomy emergency?

Answer 13

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

Question 14

How do you manage a laryngectomy emergency?

Answer 14

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

Question 15

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

Answer 15

Ask them to cough

Question 16

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?

Answer 16

Call anaesthetic team as an emergency

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

Question 17

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

Answer 17

Use bag valve mask (Ambu) over stoma site

Then use LMA if you can

Question 18

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

Answer 18

Constant humidification of the airways

Question 19

How do you manage minor bleeding of a tracheostomy?

Answer 19

Pressure

Adrenaline soaked swabs until help arrives

Question 20

how do you manage major bleeding of a tracheostomy?

Answer 20

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

Question 21

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

Answer 21

Need to inform anaesthetics and ICU

risk of developing pneumomediastinum

Question 22

5 complications can develop with a tracheostomy?

Answer 22

Blocked
Dislodged tracheostomy
Bleeding
Surgical emphysema
Pneumothorax

Question 23

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

Answer 23

LMA mask or paediatric face mask over the stoma

Question 24

How do you apply emergency oxygen to a tracheostomy patient?

Answer 24

Cover tracheostomy site with swabs or hand

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