Tracheostomy

Front 1

Tracheostomy

Back 1

** artificial airway positioned in airway**

* insertion of trach tube in place of ETT

* placed between 2nd & 3rd or 3rd & 4th cartilage below cricoid

Front 2

Advantages to trach's

Back 2

1. pt has ABILITY TO TALK
2. LESS GAG REFLEX
3. EASY TO SX
4.EASY ORAL CARE
5. NO ORAL TRAUMA

Front 3

Indications

Back 3

1. POVIDE PATENT AIRWAY following intubation
2. PREVENT ASPIRATION OF SECRETIONS
3. ALLOW LONG TERM MECHANICAL VENTILATION
4. reduce anatomical deadspace

Front 4

Hazards

Back 4

1. BLEEDING
- especially within 1st 24 hours post-op. Do not change 1st 2-3 days

2. PNEUMOTHORAX
- during procedure

3. INFECTION
- of stoma/ lungs

4. SUB Q EMPHYSEMA
- or mediastinal

Front 5

RT's trach responsibilities

Back 5

1. MAINTENANCE
- of patent airway

2. PROVIDE HUMIDIFICATION

3. SX
- prn

4. INFECTION PREVENTION

5. MAINTAIN TUBE POSITION
- if not maintained in correct alignment, can push against tube and occlude airway

Front 6

Cuffed trach's

Back 6

* provide seal between upper and lower airway to PREVENT ASPIRATION of food and secretions.

* MAINTAIN A SEAL DURING MECHANICAL VENTILATION

* cuffs are not for holding tube in place

Front 7

Double Cannula trach

Back 7

* OUTER CANNULA

* INNER CANNULA ****ALWAYS EXTRA NEXT TO BED**
- disposible: wings
- non disposible: knob turns

* OBTURATOR **ALWAYS EXTRA NEXT TO BED**
- guide to feed trach tube through stoma if dislodged

* CUFF W PILOT BALLOON


-

Front 8

Single Cannula trach

Back 8

* appropriate for permanent trach's and pts w minimal secretions

* PEDS

Front 9

Fenestrated trach's

Back 9

* ALLOWS PT TO SPEAK

* HAS
- OC
- IC
- OBTERATOR
- CUFF
- CAP/ PLUG (keeps air from OC when fenstration is used

Front 10

2 uses of Fenestrated trach's

Back 10

1. Feature not is use
- works just like other trach tubes
a. put in IC and lock in place
b. INFLATE CUFF
- tube is used this way when on vent or eating
- pt will be breathing and coughing up secretions through tube

2. Fenestration in use
a. DEFLATE CUFF
b. remove inner cannula
c. place plug in OC and lock it
- pt will now breathe through nose and mouth
- pt can cough secretions through mouth because CUFF IS DEFLATED

Front 11

Passy Muir valve (PM valve)

Back 11

* one way valve that fits over trach

* ALLOWS INSPIRATION THROUGH TRACH, BUT NOT EXPIRATION

* air is directed through vocal coreds allowing pt to speak

* MUST DEFLATE CUFF

Front 12

Trach care equipment

Back 12

* TRACH DRESSING KIT W STERILE GLOVES
* 2 pair clean gloves
* SX KIT W CATHETER & STERILE GLOVES
* 10ml syringe
* O2 & SX SOURCE
* ambu bag
* eyewear, mask w faceshield & gown

Front 13

IN CASE OF EMERGENCY

Back 13

* ALWAYS ENSURE EXTRA TRACH AND OBTURATOR OF SAME SIZE IS TAPED ABOVE PT BED

* AMBU BAG W PED MASK

Front 14

DONT FORGET

Back 14

* MUST PROVIDE A SOURCE OF HUMIDITY for any pt w upper airway bypassed

Front 15

Trach care procedure

Back 15

1. Gather supplies (trach care kit, gloves, gown & mask)

2. Wash hands, don gown, mask & clean gloves

3. Introduce yourself, check ID, explain procedure

4. Assess pt: noting RR, Spo2, BS & Sx prn

5. Open trach care kit

6. Take out sterile drape & open it on flat surface

7. Dump contents of kit on sterile drape

8. Fill lrg section of tray w 1/2 hydrogen peroxide and 1/2 sterile H2O

9. Fill both smaller sections w sterile H2O

10. Move aside O2 mask & remove inner cannula

11. Remove old dressing gauze around trach

12. REPOSITION O2 MASK IF PT DE-STATS QUICKLY

13. If inner cannula is disposible, put on sterile gloves & insert new one

14. If non-disposible, place it in lrg section to soak

15. Put on sterile gloves

16. Pick up inner cannula & clean inside & out w brush

17. Rinse off in sterile H2O & dry off w 4x4 gauze pads & inside w pipe cleaners

18. Replace inner cannula, ensure it's locked

19. Using q-tips, soaked in peroxide/ sterile H2O solution, clean plate from inside to outside

20. Rinse off solution w q-tip & gauze pads dipped in sterile H2O. Dry w 4x4 pads.

21. Remove old trach ties, have assistant hold in place w finger

22. Replace dressing gauze under trach plate

23. Insert new trach ties & secure

24. Replace O2 mask

25. Note pt condition, RR, Spo2, BS, etc

26. Doff gloves, gown, mask & chart