Tracheostomy

Question 1

What is an artificial airway?

Answer 1

An artificial airway is inserted in a patient who may or MAY NOT be breathing on their own. Can be emergent or non-emergent.

Question 2

What is a tracheostomy tube?

Answer 2

Plastic or metal tube that fits through a stoma in the neck

Question 3

What do most tracheostomy tubes have?

Answer 3

Outer cannula with an attached flange and cuff with a REMOVABLE inner cannula.

Question 4

What are some indications for a tracheostomy?

Answer 4

Acute airway obstruction (tumor/swelling), airway protection (after head/neck cancer surgery), facilitate removal of secretions, and prolonged intubation.

Question 5

Why is a tracheostomy better than prolonged intubation?

Answer 5

Less damage to airway, more comfortable, allowed to eat, mobility is improved (tube more secure)

Question 6

What are the two types of trachs?

Answer 6

Shiley and Jackson

Question 7

Describe a Shiley trach.

Answer 7

Has a disposable inner cannula, cuff, and obturator. Is plastic and used short term.

Question 8

Describe a Jackson trach.

Answer 8

Has a REUSABLE inner cannula, NO CUFF, and an obturator. Metal inner cannula and used long term.

Question 9

What is an obturator?

Answer 9

Used to insert a trach (think guidewire)

Question 10

What is the purpose of a cuffed trach (Shiley)?

Answer 10

Helps create a snug fit in trachea to prevent aspiration and help the ventilator give stronger breaths

Question 11

When are cuffs inflated?

Answer 11

When a patient is mechanically ventilated. The inflation is specifically ordered by physician.

Question 12

If you should need to deflate the cuff, what should you do?

Answer 12

Suction the oropharynx (mouth) beforehand. Deflate the cuff. Then suction the trachea afterwards.

Question 13

What are the dangers of prolonged or over-inflation of the cuff?

Answer 13

Increased mucosal pressure, causing ischemia, softening cartilage & mucosal erosion

Question 14

What can be used in order for a patient to communicate with a trach?

Answer 14

Passy-Muir speaking valve

Question 15

What should you think about when using a Passy-Muir?

Answer 15

Cuff is DEFLATED when in use, if patient is in any kind of respiratory distress-do not use, must have an OK to use from an MD (usually coordinated with SLP or RT)

Question 16

When would tube dislodgment and accidental decannulation occur?

Answer 16

Usually happens when patient is coughing or during times of transition

Question 17

What should you do if tube dislodgment and accidental decannulation occurs?

Answer 17

Keep obturator taped at bedside. Insert obturator into outer cannula. Extend neck and open tissue; insert outer cannula/obturator. Remove obturator immediately. Check bilateral breath sounds. Secure trach.

Question 18

What are nursing problems for a patient with a trach?

Answer 18

Ineffective airway clearance, impaired verbal communication, risk for infection, impaired swallowing, body image disturbance, and anxiety.

Question 19

What is the nurses job when it comes to trachs?

Answer 19

Trach assessment and trach care

Question 20

How often is trach care performed?

Answer 20

Every 12 hours