Tracheotomy and Tracheostomy Flashcards
Definition of Tracheotomy
Opening of the airway/trachea at any level
Indication for Tracheotomy
•Primarily an Emergency/acute Procedure, but it is semi-permanent in case it needs to become a more permanent airway-TracheOStomy…
How long is a Tracheostomy intended to remain?
Tracheotomies are intended to be CLOSED, 5-7 days, or made to be a more permanent airway tracheOStomy
Acute Tracheostomy
◦Choking (obstruction in airway, remember the fish story she told us)
◦Face has been crushed
Ventilator (tell me everything you know)
-mechanical pump
•May be attached to the tracheotomy tube and fed right into airway
•May be inserted orally (the tracheotomy tube is still in place)
◦If tube is in mouth, it’s placed deep enough to go between the TRUE VOCAL FOLDS. This is one of the biggest problems with venting through the mouth.. it disturbs the TVFs and can cause granulomas.
◾This situation cannot be maintained long term
◾However, a vent through the mouth makes it so you can manage both the airway and the lungs.
◦You can manipulate the air pressure, if it’s difficult to fill the patient’s lungs so you can get some good oxygenation.
◦The decision to create a TracheOStomy largely depends on how long they suspect the patient will need to be on a ventilator, or how long it will take for the airway issue to resolve.
What is the biggest indicator for a Tracheostomy?
Length of time on ventilator
◾5-7 days is longest time they will allow oral vent
◾Longer than that=granulomas
◾Edema/swelling will result from having the ventilator between the TVFs (the glottis=space between tvfs)
•Subglottal and supraglottal swelling.
Pump Failure
• The breathing mechanism, all of our respiratory musculature may be non-functioning. (Parkinson’s, MS, ALS, or other neurological diseases progress to eventually cause Pump Failure)
-Flail Chest (type of pump failure) Boney Structure of Resp. structure may be broken. Not just a couple of broken ribs, think “crushed” rib cage. Much more common before proper seat belts, airbags, and collapsible steering column.
◾If boney chest is not complete, contraction of resp. muscles means rib cage contracts, rather than lung tissue expanding, NO INHALATION.
◾With all these broken bones it’s going to be a while before they can withstand the forces of respiration, and a tracheOStomy, is put in place to avoid long term Boney Structure of Resp. structure may be broken. Not just a couple of broken ribs, think “crushed” rib cage. Much more common before proper seat belts, airbags, and collapsible steering column.
◾intubation.
Other indicators for Trachesotomy
-Pump failure
•Injury to Brain, Brain stem, Spinal Cord that causes paralysis of respiratory musculature which can result in Pump failure. This paralysis may resolve, but remember:
◦PNS damage is robust
◦CNS damage is not robust
◾Think Christopher Reeve’s Tracheostomy, with external pump due to paralysis.
◾Blockages of airway, Broken Larynx, swelling in Airway that will cause Pump Failure.
Intubation (tell me everything you know)
◾Patient can be intubated without ventilation
◾Oral infection/abscess is a risk for long term intubation
◾Tooth infection(s)
◾You don’t want to keep intubation until abscess/infection
◾Truth is: oral infection can kill you
◾Teeth are close to brain
◾Meninges are very susceptible to local infection
Cleaning and moving secretions
◾We constantly create mucous everywhere in our bodies, and that mucous has to be mobilized.
◾The mucous of the lungs is moved by cilia up into the upper trachea, and then expelled during a cough or swallow.
◾If you cannot clear these secretion you will asphyxiate on your own secretions.
◾Sedentary secretions can create Pneumonia
◾Pneumonia can KILL!
◦A Tracheostomy creates a direct route to clearing secretions from airway.
Progressive Neurological Disease
◾Patients with Neurological Diseases see this Pump failure coming.
◾By the time Resp. System gives out, the cognition has been gone for a while because of perfusion
•Perfusion means the amount of oxygen available to the brain,
•With Prog. Neurological diseases the resp. system has been failing so the brain has been without proper amounts of O2 for a while.
Surgeries than may require Tracheostomy
◾Any skull or meningeal/ dura surgery
•Brain swelling will put pressure on Brain stem (lizard brain which controls basic function: resp. heart rate, awareness) Respiration is at real risk
•head and Neck Cancers will result in Tracheostomy
•TBI
•You create airway in advance, you don’t start surgery and wait to see if respiration is affected. You plan ahead.
Definition of Tracheostomy
Semi-permanent creation of airway
- removal of tracheal cartilage
- placed below the level of the larynx
Paradoxical Vocal Fold Motion (PVFM)
- vocal folds close and do not open again
- can be lethal
- typically female, anxious, perfectionists
- usually “grow out of it”, mature psychologically
Management of Secretions
◦One of the big jobs of maintaining a tracheostomy is suctioning
◦You will suction out the trach. to keep airway as healthy as possible.
◦Most anyone can suction out a trach, even the patient themselves can suction it.
◦The issue for SLPs is that we will be working on speech with patients with a tracheostomy.
◾But before we can work on speech, we will need to ensure that their Trach is clean and Patent (open)
◾So we need to know about feeding, swallowing, breathing, maintenance of Trach.
◦Suctioning keeps the airway Patent (open) to improve oxygenation. Do not mention this term to a pt family- its medical jargon.
