Tracheostomy Care Flashcards
What are 3 possible reasons for tracheostomy insertion?
- bypass an obstruction
- remove secretions
- o2 delivery
Define Cricothyrotomy
- emergency airway procedure
- between cricoid and thyroid cartilage
- ACPs can perform, if authorized
Define Tracheostomy
- planned surgical procedure
- inferior to cricothyroid membrane
- can be temporary or permanent
- can be done because of an emergency, or elective/routine procedure
What are some possible complications from a tracheosotmy?
- hemorrhage
- airway compromise
- subcutaneous empohysema
- infection
- stomal cellulitis
- Fractured tracheal rings
- increased secretions
- bronchospasm
What are the 4 classifications of trach tubes
Cuffed
- dual
- single
Uncuffed
- dual
- single
What are the benefits of cuffed tracheostomy tubes?
- forms a seal against tracheal tubes
- all inspired and expired air passes through tube
- may be filled with air, foam or water
- intended for pts who require ventilation or have poor/absent ability to swallow
- used for all newly formed stomas
What are the benefits of uncuffed tracheostomy tubes?
- intended for a stable stoma
- intended for pts who can protect their own airway and have adequate coigh reflex
- allow for speech with speaking valve
- no positive ventilation required
- ideal for peds and newborn pts
Define Laryngectomy
- removal of larynx
- stoma is created ti which the upper remaining portion of the trachea is attached
- if ventilation is performed on this pt it must be done through the stoma
Purpose of laryngectomy tubes?
used to keep tracheostoma open
Are laryngectomy tubes cuffec or uncuffed?
they are always uncuffed
What does DOPE stand for in the context of trach care?
Possible issues with trachs
D - displacement of tube
O - obstruction of the tube
P - pt
E - equipment
When assessing pts with a trach what is the abbreviation you should go through to assess the pt
M - Movement of the chest during ventilation
A - Arterial Saturation (SpO2)
S - Skin colour of pt
H - hemodynamic stability
What is the information you need to know when responding to a tracheosotmy
- is it blocked or partially blocked?
- Is it cuffed or not cuffed?
- What is the outer diameter of the trach?
- When was the trach performed?
- Why was it performed?
- Can you pass a suction catheter?
- Disposable or reusable inner cannula?
- Is the trach fenestrated?
Should you preoxygenate a trach pt before suctioning?
Yes
How do you select an appropriate size suction catheter for trach suctioning?
The suction cather should be 1/2 the size of the inner diameter of the trach. So if a trachs ID is 10mm, you should use a 5 mm suction catheter or a 15 french catheter
How long do you suction for?
10 seconds
What are the steps of a fully tracheosotmy reinsertion?
- Ensure adequate ventilation of pt
- Prepare new trach tube
- remove inner cannula and deflate cuff
- Insert ibturator into outer cannula
- Lubricate end of tube
- Extend neck back to open stoma
- Gently insert tube as pt inhales, using curved upward motion
- Immediately remove obturator
- Insert inner cannula and oxygenate
