Tubes and Dysphagia Flashcards
Why would a pt need a tach tube (3)?
1) Upper airway obstruction at or above level of vf’s
2) Potential upper airway obstruction (edema post surgery)
3) Provision of respiratory care
How does a trach tube work?
Tube inserted into trachea via surgical incision b/n 3rd & 4th tracheal ring
3 parts of a trach tube:
1) Outer cannulaA (holds trach site open)
2) Inner cannulaB (actual breathing tube in trachea)
3) ObturatorC (smooth tip for initial insertion)
Swallowing with Tracheostomy:
Signs of Reflux or Aspiration
Food in trach
Endotracheal secretions
*Will need suctioning
3 types of trach tubes:
1) Cuffed
2) Cuffless
3) Fenesrated
CUFFED trach tube (3 things):
1) Prevents aspiration
2) Used w/ ventilators
3) Inflated for + pressure
- The cuff is blown up and there is no way they can aspirate bc bolus will sit on top of the cuff.
- longterm
- often used with a ventilator
CUFFLESS trach tube (4 things):
1) Aspiration may occur
2) May interfere w/ laryngeal
evelation during swallow
3) Assists breathing &
secretion removal
4) Long-term use
- Doesn’t allow as must laryngeal elevation
- longterm
FENESTRATED trach tube (3 things):
1) Smaller
2) Used for weaning &
decannulation
3) Short-term (3-5 days)
- smaller than others
- doesn’t interfere with laryngeal elevation like the others
- Can be use after a cuffed or cuffless to ween ppl off a trach tube
Swallowing Treatment with Trach (12)
1) Pt history (pt symptoms of dysphagia)
2) Know type of trach tube and if inflated (if it’s cuffed)
3) Determine length of time of trach
(If 6+ mos trached, scar tissue can restrict laryngeal elevation)
4) Deflate cuffed tube (w/ medical clearance)
- Inflated cuffs irritate tracheal wall during swallow, restricts laryngeal elevation, compresses on esophagus, reduces laryngeal sensitivity
5) Suction oral and trach as deflating
6) Pt occludes trach w/ gloved finger or gauze or one-way valve during & several seconds after each swallow for near-normal trach pressure and clearance of possible airway residues (exhalation)
7) Dry swallows first
8) Write down directions for swallowing
9) No more than 3cc liquid/paste/puree for swallow trials (start w/ easiest consistency for pt), 5-finger test, ready to suction
10) Cough! Cough! Cough! (especially after a trial swallow)
11) Phonate sustained vowel after swallow, head turn
Ventilator Dependent : Swallow usually worsens on vent (why) (3):
1) Respiration controlled by vent
2) Pt can’t lengthen exhalation for swallow (disrupted swallow)
3) Cuffed trach tube
Ventilator Dependent : Swallowing Treatment (3):
1) Timing of swallow at exhalation
2) Blue dye test (see if the blue dye comes out of the trach to see if they are aspirating)
3) Present a variety of consistencies
Intubated (problems that can occur):
1) May be laryngeal trauma from tube placement, TE (treacheoesophageal) fistula from tube rubbing
2) Laryngeal pathologies: granuloma, vf paresis/paralysis, edema, erythema (reddening/irritation)
Intubated Swallowing Treatment:
NONE UNTIL EXTUBATED for ~ 1 week!
Then ROM (range of motion) exercises before trial swallows
Don’t give them a bottle of water, maybe start with ice chips when you do do trial swallows.
Feeding Tubes: NG- Nasogastric: method
tube placed nasally
in through esophagus and end up in stromach
“Red Flags” (2)
Look at:
- Weight loss
- Hydration
Red Flags:
Weight Loss with Trach tubes (2):
1) 10% to 20% loss is common
(moderate)
2) > 20% of usual weight (severe)
Red Flags:
Hydration Issues with Trach tubes (7):
1) Rapid wt loss of 4+ lbs within 48 hrs
2) Pts with thin liquid dysphagia
3) Complaint of thirst
4) Reduced skin turgor
5) Decreased urination
6) Hypernatremia (increased serum sodium)
7) Elevated BUN (blood urea nitrogen)
