Wee 11 Tracheostomyes

Question 1

what is a tracheostomy?

Answer 1

artifical opening through neck and trachea can be surgical or precutaneous
allows bypass of upper airway and acess to lungs
tube is typically placed for airway and breathing through traceosomy and not nose/mouth

Answer 2

passed in through tracheal rings normally at 2nd plate below level of thyroid

Question 3

what is a percutaneous tracheosomty?

Answer 3

inital insertion of needel
dilation using dilater untill size required
used after 7-10 of being intubated when intubation needs to be changed to trancheostomy

Question 4

what are the indications for a tracheosotmy?

Answer 4

bypass obstructed upper airway - acute or chronic
clean and remove secretions from airway - ie poor ability to cough or spinal injury/neurodegenerated diseases
more easily and usually more safely deliver oxygen to lungs

Question 5

what upper airway resaons would a tracheostomy be required?

Answer 5

tumors, infections (epiglotitis, croup), vocal chrod paralysis, sevre neck or mouth injuries, forgine body obstruction, sevre sleep aponea, congential abnomralities, airway burns

Question 6

what lung complications may require a tracheosotomy to be placed?

Answer 6

neuromusclar disease/weakening of diaghpram, disorders of resp control, anaphylaxis, long term unconciouness/coma, fracture of cervical vertabra

Question 7

how does the speaking valve work?

Answer 7

passey meaur
one way valve
when pts are able to protect own ariway - cuff can be deflated - breath in through traceostomy but the valve is one way so air forced back out through upper airway and pt can speak

Question 8

what are the immediate complications for a trachy?

Answer 8

bleeding, air trapped - pneumothorax, subcutaneous emphhsema, damge to osophegus, nerve injury, infection, hypoxia, trachy tube blocked

Question 9

what early (tube being in place complications are there?)

Answer 9

accedental removal
bloackages
infections around tube
false passage information
aspiration
bleeding
pooling of secretions in lower airways

Question 10

what are some delayed complications?

Answer 10

thining of trachea
development of oesophegus to treachea connection - tracheo0esphegeal fistula
granulaiton tissue
narrowing or collapse of airway abocve tracheotomy
hole when removed may close on on if hasnt by 16 weeks more rusk r=for needing surgical intervention

Answer 11

lowest pressure needed never above 200mhg
only preformed for less than 10 seconds at a time adults and 5 seconds peads
pass catheter gently - gag reflex - carina and tissue around makes cough
circle as suction removed
avoid multiple passes
touch as little of catheter as possible

Question 12

what to do if a trachy has fallen out?

Answer 12

try not to replace it
consider placing oclusive dressinf over stoma and maging upper airway

Question 13

what to do if there is a blockage?

Answer 13

locate and suction
remmove inner cannula

Question 14

what to do if there is an air leak?

Answer 14

consider severity
check cuff

Question 15

what to do if there is migration?

Answer 15

gently try and return it to neutral position