Tracheostomy Care & Suctioning Flashcards
Tracheostomy
- Long-term airway support
- Opening for tube itself
Tracheostomy Tube
Tube inserted to extend through stoma into trachea
Health teaching
Encourage pt to clear airway by coughing
Stress importance of adequate hydration
What position should a pt assume?
Semi/high fowler’s
Promote lung expansion
Cotton lint/fibres
From gauze
May be aspirated, causing a tracheal abscess
Post care assessment
- Character/amount of secretions
- Drainage form tracheostomy
- Incision
- Hr and resp status, compared w baseline
- Complaints of pain/discomfort
What size syringe is used
10 ml
Why do you use minimal occlusive pressure when inflating cuff?
Prevent pressure on tracheal tissue
How do you measure appropriate tracheal cuff pressure?
- Stethoscope, auscultate at suprasternal notch for hissing
- If voice audible, occlusion is inadequate
When to perform Suctioning
PRN
resp distress/SOB/Coughing/Low O2
Cyanosis
Crackles
Complications of suctioning
- Worsening respiratory status
- Bloody secretions
- Coughing
- No secretions
Techniques to minimize complications
- Hyperinflation
- Hyperoxygenation
How long to perform suctioning
10-15 sec
If client has copious secretions:
Increase O2 delivery prior to beginning
When is suctioning necessary
When pt is unable to cough and clear respiratory tract secretions
When is oropharyngeal/nasopharyngeal suctioning used
When pt is able to cough but unable to clear secretions by expectorating or swallowing
After pt coughs
When is orotracheal/nasotracheal suctioning required?
The pt is unable to manage secretions by coughing and does not have an artificial airway
Why is a nasal insertion preferred?
Gag reflex is minimal
Tracheal suctioning
Accomplished through an artificial airway
Increase amount of secretions picked up by…
Rotating suction tube
When inserting suction tube:
Occlude tube, DO NOT suction
When is an artificial airway required?
With pts with a decreased level of consciousness or airway obstruction
Aid in removal pf secretions
How is an oral airway measured?
Distance from corner of mouth to angle of jaw just below ear
If oral airway too large
Force tongue toward epiglottis
obstruct
If oral airway to small:
Tongue is not held in anterior mouth
Endotracheal tube
Short-term artificial airway
Mechanical ventilation, relieve upper airway obstruction
Protect against aspiration
clear secretions
Maintenance/promotion of lung expansion: Ambulation
Immobility -> atelectasis and ventilator-associated pneumonia
Maintenance/promotion of lung expansion: Positioning
Frequent changes prevent atelectasis
45 degreee semi-fowlers
good lung down
pulmonary abcess = bad lung down
Incentive spirometry
Encouraging voluntary deep breathing by providing visual feedback to pts about inspiratory volume
prevent atelectasis
Chest tube
Remove air/fluids from pleural space, prevent it from reentering pleural space, reestablish normal pressures
inserted through thorax
Pneumothorax
Collection of air in pleural space
Loss of intrapleural pressure
Collapsed lung
Sharp pain
Hemothorax
Accumulation of blood and fluid in pleural cavity between visceral and parietal
Prevents full expansion
Possible affects of oxygen
Atelectasis or oxygen toxicity
Low flow devices
Nasal cannulas, simple face masks, reservior masks
Concentrations that vary w patients respiratory pattern
High flow devices
Deliver O2 above normal inspiratory rates
Venturi mask
Nasal cannula
up to 6l/min
4L/min
Not often used, drying on mucosa
If used **Humidifier
Skin breakdown
Partial rebreather
40-70%
max 10L/min
Non-rebreather
60-80%
10L/min
Venturi mask
24-60%
4-12L/min
What is an example of effective planning for emergency care for a pt with a tracheostomy
Keep an obturator and trach tube at bedside
Technique for trach ties
Square knot
ensure 2 fingers fit snugly underneath
How to ensure catheter us working
Suction a small amount of sterile water
When providing suctioning for a pt with a mask…
keep oxygen mask near face during procedure
How do you evaluate effectiveness?
Compare pre and post suctioning data
What do you do if a pt begins to gag/complains of nausea?
REMOVE