Week 2: Tracheostomy Flashcards
What does the upper airway consist of?
Nose
Oral Cavity
Pharynx
Larynx
Functions of the upper airway?
Heating/cooling inspired gas to body temperature
filtering
humidification
smell
phonation
passage for ventilation
What does the lower airway consist of?
Larynx
Trachea
Bronchi
Bronchioles
Alveoli
Functions of the lower airway?
Conducting airway for ventilation gas exchange
What are the 4 types of artificial airways?
- oropharyngeal
- nasopharyngeal
- endotracheal
- nasoendotracheal
Is insertion of an artificial airway in the scope of the RN?
not in the scope of the RN
surgical tracheostomy
usually performed in OR, but sometimes bedside in ICU
percutaneous tracheostomy
introduced via a needle and guide wire technique
Cricothyroidotomy
only performed in emergency situations not preferred due to proximity of the vocal cords
benefits of a tracheostomy tube vs endotracheal tube
- Lower risk of laryngeal injury
- shorter ventilator weaning time
- easier communication
- more comfortable
- easier to secure
- easier to do mouth care
- may start oral feeding sooner
indications for a tracheostomy
- bypass airway obstruction at or above the level of the larynx
- provide long term mechanical ventilation
- facilitate the removal of secretions
- protect the airway in patients at risk of aspiration
- vocal cord paralysis
- prevention of ventilator associated pneumonia (VAP)
complications of a tracheostomy
- abnormal bleeding
- tube dislodgement
- obstructed tube/mucus plug
- infection
- subcutaneous emphysema
- tracheo-esophageal fistula
- tracheal stenosis
- tracheal dilation
Cuffed trach
balloon on interior distal end of tube that isolates the lower airway from the upper airway
why would a patient have a cuffed tracheostomy
unable to protect their own airway from aspiration
cuffless trach
once patient can protect airway this is used
cuffless trach advantages
more comfortable
may facilitate speaking
may facilitate eating
progression towards decannulation
can be used long term (decreased trans tracheal damage risk)
cuffless trach disadvantages
does not protect against aspiration
cannot provide adequate ventilation is event of code blue
may dilute O2 received through trach mask by mixing with room air O2 from upper airway
increases leak for ventilated patients
Purpose of the outer cannula
maintains patency of stoma
purpose of the inner cannula
protects the patency of the tracheostomy tube and can be removed to restore patent airway if occluded
purpose of the obturator
reduces trauma during insertion by being blunt tipped
Purpose of tracheal plug
occludes trach tube to redirect air around instead of through tube for weaning purposes
Purpose of flange
prevents outer cannula from descending further into trachea
Emergency Airway equipment
Ambu bag
Mask
Oral airway
non disposable inner cannula
Trach emergency airway supplies
cuffed trach tube same size and one size smaller
trach dilator set
10cc syringe
trach tube exchanger
1 pack water soluble lubricant
obturator
