Tracheostomy

Question 1

what is tracheostomy

Answer 1

it is a surgical opening in the anterior wall of the trachea to facilitate ventilation/ inspiration. surgical- patients lies in a supine position and Cx placed in ext, with a 2-3cm incision is made (made between 2-4 tracheal rings), percutaneous- placed under guide wires (placed in between first and second tracheal rings) which then separates the trachea to allow insertion- doesn’t require surgery

Question 2

indications

Answer 2

to maintain an airway, to bypass possible or actual upper airway obstructions, protections of trachea-bronchial tree, to assist in removal of bronchial secretions, prolonged need for artificial ventilation, to facilitate weaning from a ventilator, total laryngectomy, reduces anatomical dead spaces- makes breathing easier

Question 3

pros of tracheostomy

Answer 3

increased patient mobility/ comfort, ease for suctioning, aids weaning from mechanical ventilation, decreases anatomical dead space, enables/assist communication, enables oral intake, decreased risk of infection

Question 4

cons of tracheostomy

Answer 4

blocked/displaced tubes, infections, long term tracheal damage, aspiration risks, psychological effects, scar formation, long term vocal cord damage

Question 5

features of tracheostomy tubes

Answer 5

shaft- airway bit, flange- bit around the outside, cuff- at end of pillow balloon, blown up to block airway, pillow balloon- where air is ejected, 15mm connector, inner tube
attachments- speaking valves, caps and spigots

Question 6

types of tubes

Answer 6

single cannula- one tube, double cannula- outer and inner part, fenestrated (wholes in tubes, aids in weaning)/non-fenestrated, cuffed/un-cuffed, adjustable flanged

Question 7

effects of tracheostomy on humidification

Answer 7

drying of secretions, loss of normal filtering systems, reduced mucocillary transport, reduced airway pressure

Question 8

humidification

Answer 8

hydration, warm/cold water systems, nebulisers, saline installation, swedish nose/thermovent, buchanan bibs

Question 9

what is weaning

Answer 9

a planned sequential process that allows early return from a dependant stat to independence

Question 10

weaning- beginning the process

Answer 10

mechanical ventilation- CPAP- trachy mask-deflate cuff-speaking decantation cap- decantation

Question 11

importance of weaning and decannulation

Answer 11

decreased risk of complications, decreased stress, psychological boost for patients, may promote speed of recovery, cost savings, decreased dependency of patient on MDT

Question 12

criteria for tracheostomy weaning

Answer 12

primary cause resolved, adequate nutritional state, adequate sleep, psychological support, able to protect airways- adequate ventilatory reserve- spontaneous breathing off ventilator for 24-48hours, O2 <40%, manageable secretions- CVS stable

Question 13

failed decannulation

Answer 13

decreased saturations, changes in HR (ECG), increased RR, increased WOB, inability to cough and expectorate, fatigue, stridor

Question 14

continuation of tracheost

Answer 14

upper airway obstruction, severe neurological deficit, inability to maintain own airway, persistent severe aspiration, severely reduced lung compliance

Question 15

tube changes- consider

Answer 15

timing, type of procedure, type of tube, progression of weaning, patients medical conditions, resus knowledge, emergency equipment, 2 operators, patient consent (where possible), competence

Question 16

tube changes- complications

Answer 16

inability to replace tube, placed in parastomal tissue, excessive coughing, trauma/bleeding, aspiration, arrest, tracheal rings