Week 5 Flashcards
What is a tracheostomy?
A tracheostomy is an opening artificially created through the neck into the trachea.
It allows complete bi-pass of the upper airway with direct access to the lungs.
•A tube is usually placed through the opening artificially created to provide an alternative airway and to remove secretions from the lungs.
What are the indications for a tracheostomy?
•to bypass an obstructed upper airway;
• to clean and remove secretions from the
airway;
• to more easily, and usually more safely,
deliver oxygen to the lungs.
what are some upper airway problems that require a tracheostomy?
- Tumors,
- Laryngectomy
- Infection, such as epiglottitis or croup
- Subglottic Stenosis; Subglottic Web
- Vocal cord paralysis (VCP); Laryngeal injury or spasms
- Congenital abnormalities of the airway
- Large tongue or small jaw that blocks airway
- Severe neck or mouth injuries
- Airway burns from inhalation of corrosive material, smoke or steam
- Obstructive sleep apnea(severe)
- Foreign body obstruction
what are some lung porblems that require a tracheostomy?
- Need for prolonged respiratory support, such as Bronchopulmonary Dysplasia (BPD)
- Chronic pulmonary disease to reduce anatomic dead space
- Chest wall injury such as a flail
- Diaphragm dysfunction
What are some other reasons for a tracheostomy?
- Neuromuscular diseases paralysing or weakening thorax muscles and the diaphragm
- Aspiration related to muscle or sensory problems in the throat
- Fracture of cervical vertebrae with spinal cord injury
- Long-term unconsciousness or coma
- Disorders of respiratory control
- Facial surgery and facial burns
- Anaphylaxis (severe allergic reaction)
- Obviously some will stay insitu a short time while others are long- term or permanent
What are the ventilation styles?
• Positive pressure
- Ventilator (hospital)
- BiPAP or CPAP(hospital, rehab or home)
• Humidification
- Temperature set
- evaporative
• Atmospheric pressure, room air with a basic cover(or not)
What are some immediate complications of a tracheostomy?
– Exsanguination(bleeding)
– Air trapped around the lungs (pneumothorax)
– Air trapped in the deeper layers of the chest
(pneumomediastinum)
– Air trapped underneath the skin around the
tracheostomy (subcutaneous emphysema)
– Damage to the oesophagus
– Injury to the nerve that moves the vocal cords (laryngeal nerve)
– Tracheostomy tube can be blocked by blood clots, mucus or pressure of the airway walls.
– Infection
– Hypoxia
What are some early complications of a tracheostomy?
– Accidental removal of the tracheostomy tube (accidental decannulation)
– Blockages
– Infection in the trachea and around the tracheostomy tube
–Wind pipe itself may become damaged for a number of reasons, including pressure from the tube; bacteria that cause infections and form scar tissue; or friction from a tube that moves too much
– Falsepassageformation
– Aspiration
– Bleeding
– Pooling of secretions causing infection in lower airways and aspiration
What are some delayed complications of tracheostomy?
- Thinning (erosion) of the trachea from the tube(and cuff) rubbing against it (tracheomalacia)
- Development of a small connection from the trachea to the oesophagus which is called a tracheo-esophageal fistula
- Development of bumps (granulation tissue) that may need to be surgically removed before decannulation can occur
- Narrowing or collapse of the airway above the site of the tracheostomy, possibly requiring an additional surgical procedure to repair it
- Once the tracheostomy tube is removed, the opening may not close on its own. Tubes remaining in place for 16 weeks or longer are more at risk for needing surgical closure
what do you need to consider when caring for a stoma?
- Meticulous care towards hygiene and asepsis is necessary.
- Remember that the skin surrounding the stoma is also prone to irritation.
- There may also be other factors which may alter skin integrity, radiotherapy.
- The area should be cleaned with normal saline and barrier cream applied to the local skin (cotton wool should be avoided).
- Consider a soft absorptive dressing to keep the skin dry to reduce general degradation
what do you need to consider when caring for a trachy tube?
- Inner cannula needs to be removed and washed with sterile water.
- For cuffed tracheostomy tubes, the pressure should be measured twice daily and maintained between 15-30 cmH2O (15-25 cmH2O for children).
What should you consider with suctioning a trachy tube?
- Use the lowest pressure needed (usually <120 mm Hg and definitely not beyond 200 mm Hg). For non-adults the following pressures are recommended: 60-80 mm Hg for neonates, 80-100 mm Hg for children, and 80-120 mm Hg for adolescents
- Suctioning should only be performed for less than 10 seconds at a time in adults and not longer than 5 seconds in paediatrics.
- Pass the suction catheter down the tracheostomy gently. You may stimulate a coughing reflex upon contact of tissue around the carina.
- Circle as the suction catheter is removed
- Avoid multiple passes with each suction catheter as you may be introducing infection further into the larger bronchioles.
- Touch as little of the catheter as possible for infection control
What should a paramedic do if a tracheostomy falls out?
Do not try replace it unless it’s a last resort.
– Consider placing an occlusive dressing over the stoma and managing the upper airway as normal
What should a paramedic do if a tracheostomy becomes blocked?
– Locate and suction.
– Remove the inner cannula
What should a paramedic do if a tracheostomy has an air leak?
– Consider severity
– Check the cuff
What should a paramedic do if a tracheostomy has moved?
Gently try and return it to neutral position
What suction pressures should be used for a tracheostmy?
For non-adults the following pressures are recommended: 60-80 mm Hg
for neonates, 80-100 mm Hg
for children, and 80-120 mm Hg for adolescents
