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
What does a “D” indicated on a trach flange?
That the tube is disposable
Purpose of Tracheostomy care?
- Maintain patency of trach tube
- Maintain integrity of the skin and mucous membrane
- Prevent infection
What is involved in Tracheostomy care?
Stoma care and dressing changes, inner cannula care, and changing trach ties
How often is Tracheostomy care performed?
After 24hrs, is done dailiy and if soiled
- long term trachs may not require a dressing
How often are Tracheostomy ties changed?
After 24hrs, only when soiled
When is Tracheostomy care require sterile procedure vs clean?
Sterile gloves are to be worn for the first 72 hours. After that period, normal clean procedure
Reference
https://learn.sait.ca/content/enforced/612444-202320RESP-319-A/course_files/Trach%20%26%20Other%20Lab%20Materials%202018/Trach_TracheostomyCare.pdf?ou=612444
Emergency interventions for Trachs: (add in later)
https://learn.sait.ca/content/enforced/612444-202320RESP-319-A/course_files/Trach%20%26%20Other%20Lab%20Materials%202018/Trach_EmergencyIntevention.pdf?ou=612444
full ref if needed
https://learn.sait.ca/content/enforced/612444-202320RESP-319-A/course_files/Trach%20%26%20Other%20Lab%20Materials%202018/Trach%20Learning%20Module.pdf?ou=612444
