Tracheostomy

Question 1

what are the purpose and principles of upper airway suctioning?

Answer 1

> when noninvasive techniques and medications are insufficient to maintain a patent airway

> using a yankauer

> suctioning in the lower airway is needed when PTs cannot cough forcefully enough to clear secretions.

> when lower airway needs to be suctioned, it needs to be sterile.

Question 2

how to suction

Answer 2

> auscultate for baseline and breath sounds

> pulse, resps, bp… nasal flare, drooling,

> contraindicated to nasotrachael suction: facial trauma, nasal bleeding

Question 3

oropharyngeal airway

Answer 3

different sizes for ppl
measure flange parallel to teeth and the curved part next to the cheek- tip should be at the angle of the jaw

goes up to size 10

average adult is size 4.

> used when person has no gag reflex or they would gag it out

Question 4

nosopharyngeal airways

Answer 4

size 20-26 french

> 5-6 mm in diameter

> for people that have a gag reflex

Question 5

Nasotracheal/tracheostomy suctioning

nasotracheal tubes- placement checked via x-ray for 1-2 cm above carina

Answer 5

1. position PT in semi-high fowlers
2. get suction kit or suction catheter
3. fill basin with sterile NS 100ml
4. if nasotracheal- get lube
5. set wall regulator to 100-150 mmHg, any higher can do damage
6. apply mask and sterile gloves, apply the non-sterile suction tubing to sterile suction with approp hands
7. coat distal cath in sterile water to reduce trauma 6-8cm
8. might need to hyperoxygenate prior to minimize postsuctioning hypoxemia
9. remove O2 device and insert cath into nares during inspiration without applying suction
10. as PT takes deep breath, advance cath to just above enterance to trachea. quickly insert cath 15-20cm in adults
11. apply suction for no longer than 15 sec by placing and releasing thumb of non-dominant hand over vent while slowly withdrawing and rotating back and fourth.. encourage PT to cough if poss.
12. do not perform more than two passes and allow for 1-2 min between each pass.
13. for the second pass, rinse catheter in the sterile bowl by suctioning water to clear secretions.

Question 6

for trach tube suctioning

Answer 6

> insert cath into artificial airway until resistance is met and pull back 1cm

> use thumb for vent

> only 15 sec, encourage pt to cough

> i could use same cath to suction the upper airway but not to put it back into lower airway

> insert cath with PT inhales!!!
suction with exhale

Question 7

ET Tube care

in mouth! for temp 10-12 days
to maintain patent airway

Answer 7

1. need 2 ppl
2. get one to hold ET tube firmly so that it doesnt fall out
3. remove velcro and tube holder plus oral airway
4. keep cuff inflated and clean mouth/gums/teeth with help of assistant to hold tube.

Question 8

Trach care

Answer 8

1. suction trache and remove old dressing
2. prepare at bedside–> sterile thache kit

3- 4x4 gauze pads and pour NS into bowl

4. open two cotton swabs
5. open new trach holder
6. apply sterile gloves
7. remove O2 source
8. swap nondisposible inner canula with another if nondispose. OR place new cannula instead
9. clean around stoma with cotton swabs and outer cannula surfaces 5-10cm out
10. dry
11. with help of partner, change the ties around neck. once new one is on. insert new slit gauze under ties trying not to touch and contaminate.
12. check resp status

Question 9

anatomy trache

Answer 9

10-12cm average adult

2.5cm diameter

16-20 rings

Question 10

what is a tracheostomy?

Answer 10

> artificial opening for airway

> surg created btwn 2-3rd cart rings

> temp or permanent (Ca, ALS, MG)

> kept open by insertion of trach tube

> shortens the length of the upper airway, decreases dead space

> decreases the work of breathing for PTs

> cuffed/uncuffed

> fenestrated/not

Question 11

indications

Answer 11

> Ca, obstruction

> upper airway bleed

> trauma/burns

> prolonged artificial vent

> resp insufficiency- muscular deficiency disease

> inability to clear secretions effectively

> inability to protect own airway

Question 12

complications of trach

Answer 12

1. airway occlusion
2. tissue damage
3. infection
4. communication diff
5. tube displace/dislodge
6. bleeding
7. tracheo-esophageal fistula
8. inability to maintain nutrition/hydration needs
9. air leaks
10. loss of normal airway function

Question 13

nursing implications

Answer 13

1. prep
2. assess Pt
3. pt education
4. communication/body image
5. procedures
6. emergencies
7. guidelines and documentation

Question 14

preparation

Answer 14

> equip at bedside
PT assessment
Pt correct position
2nd nurse to help

Question 15

some Pt assessment:

Answer 15

1. size /type of tube
2. cuffed/uncuffed
3. humidification method
4. suction? how often?
5. sputum? color amnt
6. cleaning
7. can pt cough/swallow?
8. weaning progress
9. mouth care** use suction toothbrush q shift

Question 16

humidification

Answer 16

> upper airway moistens air. bypassed with trach
hummidify moistens the air
potential for fluid build-up
insufficient/ excess

Question 17

when do you suction?

Answer 17

> visible/audible secretions
>suspected aspiration
>dropping peripheral O2 sat
>increased coughing
> reduced airflow

suction smaller than trach 12-14 fr

keep emerg equip at bedside!!!
>suction device, o2, masks, neck band and gauze, syringe, scissors
if trach falls out, put another in!

Question 18

suctioning can cause:

Answer 18

> hypoxia
trauma
infection
as necessary