Week 2: Tracheostomy

Question 1

What does the upper airway consist of?

Answer 1

Nose
Oral Cavity
Pharynx
Larynx

Question 2

Functions of the upper airway?

Answer 2

Heating/cooling inspired gas to body temperature
filtering
humidification
smell
phonation
passage for ventilation

Question 3

What does the lower airway consist of?

Answer 3

Larynx
Trachea
Bronchi
Bronchioles
Alveoli

Question 4

Functions of the lower airway?

Answer 4

Conducting airway for ventilation gas exchange

Question 5

What are the 4 types of artificial airways?

Answer 5

1. oropharyngeal
2. nasopharyngeal
3. endotracheal
4. nasoendotracheal

Question 6

Is insertion of an artificial airway in the scope of the RN?

Answer 6

not in the scope of the RN

Question 7

surgical tracheostomy

Answer 7

usually performed in OR, but sometimes bedside in ICU

Question 8

percutaneous tracheostomy

Answer 8

introduced via a needle and guide wire technique

Question 9

Cricothyroidotomy

Answer 9

only performed in emergency situations not preferred due to proximity of the vocal cords

Question 10

benefits of a tracheostomy tube vs endotracheal tube

Answer 10

1. Lower risk of laryngeal injury
2. shorter ventilator weaning time
3. easier communication
4. more comfortable
5. easier to secure
6. easier to do mouth care
7. may start oral feeding sooner

Question 11

indications for a tracheostomy

Answer 11

1. bypass airway obstruction at or above the level of the larynx
2. provide long term mechanical ventilation
3. facilitate the removal of secretions
4. protect the airway in patients at risk of aspiration
5. vocal cord paralysis
6. prevention of ventilator associated pneumonia (VAP)

Question 12

complications of a tracheostomy

Answer 12

1. abnormal bleeding
2. tube dislodgement
3. obstructed tube/mucus plug
4. infection
5. subcutaneous emphysema
6. tracheo-esophageal fistula
7. tracheal stenosis
8. tracheal dilation

Question 13

Cuffed trach

Answer 13

balloon on interior distal end of tube that isolates the lower airway from the upper airway

Question 14

why would a patient have a cuffed tracheostomy

Answer 14

unable to protect their own airway from aspiration

Question 15

cuffless trach

Answer 15

once patient can protect airway this is used

Question 16

cuffless trach advantages

Answer 16

more comfortable
may facilitate speaking
may facilitate eating
progression towards decannulation
can be used long term (decreased trans tracheal damage risk)

Question 17

cuffless trach disadvantages

Answer 17

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

Question 18

Purpose of the outer cannula

Answer 18

maintains patency of stoma

Question 19

purpose of the inner cannula

Answer 19

protects the patency of the tracheostomy tube and can be removed to restore patent airway if occluded

Question 20

purpose of the obturator

Answer 20

reduces trauma during insertion by being blunt tipped

Question 21

Purpose of tracheal plug

Answer 21

occludes trach tube to redirect air around instead of through tube for weaning purposes

Question 22

Purpose of flange

Answer 22

prevents outer cannula from descending further into trachea

Question 23

Emergency Airway equipment

Answer 23

Ambu bag
Mask
Oral airway
non disposable inner cannula

Question 24

Trach emergency airway supplies

Answer 24

cuffed trach tube same size and one size smaller
trach dilator set
10cc syringe
trach tube exchanger
1 pack water soluble lubricant
obturator

Question 25

What skills can a student do with supervision?

Answer 25

change dressing
suction clean change inner cannula

Question 26

What skills can a student NOT do

Answer 26

change or remove trach
inflate or deflate trach cuff
change trach ties

Question 27

Purpose of suctioning

Answer 27

maintain airway patency
promote optimal gas exchange
decrease chance of infection

Question 28

Indications for suctioning

Answer 28

rattling gurgling
ineffective cough
visible secretions
change is resp status
dyspnea, restlessness, irreg breathing, accessory muscles
pale or dusky colour
requested by patient physio etc.

Question 29

Complications of suctioning

Answer 29

Tracheal mucosal damage
Hypoxia
Dysrhythmias
lung collapse
infections
bronchospasm
low BP
increased ICP, intra abominal and intra thoracic pressures

Question 30

How often should a trach dressing change and care be one?

Answer 30

At least twice daily and PRN