Tracheostomy care Flashcards
What are indications for Tracheostomy Care?
- Obstruction of inner cannula
- SpO2 low
- Thick secretions
- Increased WOB
- with every routine monitor
What safety equipment should you have ready for Tracheostomy care?
- tracheostomy bag
- Downsized trach
- Obturator
- Bagger w/pediatric mask for bagging the stoma site directly
What equipment is used in tracheostomy care?
- Tracheostomy cleaning kit
- 4 Q-tips for drying (kit contains 4
more Q-tips) - Drain sponge (2x2)/AMD
dressing with or without foam –
manages moisture and bacteria
better than drain sponge - Normal saline
- Inner cannula (if required)
- Open suction supplies
- Pressure manometer
- Syringe 10CC
- PPE (gloves, goggle, preferably gown)
How do you check for tube patency?
- visualize the inner cannula by removing it from the pts tracheostomy and assessing the % of spoiling
- Ability to pass the suction catheter. Confirms you don’t have a blockage
Visualization Techniques for assessing tube patency?
- Preoxygenate the patient
- Remove the O2 delivering device, quickly pass suctioning catheter to assess for patency
- if unable to clear suction catheter, remove inner cannula and assess for soiling
- if inner cannula needs to be changed then switch out for another one or clean the disposable
- insert the clean/new cannula back into the tracheostomy tube
- Chart the occurrence in the patient chart
In adults, what are the suction pressures used?
- Close/inline: 120-150
- open: 80-120
What are suction pressures in children?
80-100 mmHg
What are suction pressure for infants?
60-80mmHg
Withdraw time for adults, kids, and infants?
- entire procedure time?
- A: 15-20 (30tot)
- K: 10-15 (25 tot)
- I: 5 (20tot)
Meconium Aspirator pressure?
80-100
RSBI for extubating?
(RR/Vt) = tobin score
- RSBI <105 is ready for extubation
How do you determine if a Trach is cuffed or uncuffed based on the flange?
- Number in front of the tube indicates sizing
- CF = features outer cannula = cuffless
- FEN and LPC don’t have CF; meaning they have a cuff
- i.e Shiley CFN = cuffless fenestrated tube
How do you determine if a trach is fenestrated based on the flange?
- A “N” at the end usually indicated a fenestrated tube
- A “S” indicates solid; meaning no fenestration
- i.e Shiley CFN = cuffless fenestrated tube
Why do we use fenestrated tubes/trachs?
Aids in the ease of weaning
- helps patient speak while on a vent or the trach hole is covered
What is a fenestrated tube/trach
Fenustrated means there is a hole towards the vocal cord
- allows the patient to speak while vented
