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Assignment 6

white clinical lab competencies


Chapter 18 page 380 to 392, questions

Nasotracheal intubation

More difficult than orotracheal intubation


Performed either blindly or with visualization


(can use magill forcepts and laryngoscope)


:direct visualization requires either standard or fiberoptic laryngoscope


Steps for nasotracheal intubation are similar to those of orotracheal intubation


Extubation decannulation

Extubation: process of removing oral or nasal endotracheal airway


Decannulation: process of removing trachesotomy tube



Assess patients readiness for extubation or decannulation


:original problem is no longer present


:quantity and thickness of secretions


:upper airway patency


:presence of intact gag reflex


:Ability to clear airway secretions


Extubation Procedure

Assemble equipment


Towel, scissors, gloves, suction, O2 device, syringe


explain procedure to patient


Pre oxygenate patient, remove ETT tape


Suction oropharynx


Extubation procedure


Insert catheter


:instruct patient to "take a deep breath" when instructed (count to 3 etc)


Deflate the cuff and remove the tube swiftly


:applying suction throughout withdrawal


Apply O2 auscultate lungs and neck for stridor


Check SpO2, instruct patient to deep breath and cough

Steps of extubation

Step 1 assemble needed equipment


Step 2 suction endotracheal tube and pharynx above cuff


Step 3 oxygenate patient


Step 4 deflate cuff


Step 5 remove tube while applying suction as you withdrawl


Step 6 apply appropriate oxygen and humidity therapy


:O2 with cool mist which is usually about 2 to 10 micros coming out of LVN


Step 7: assess/reassess patient


:Check for good air movement by auscultation

Laryngectomy tube

If larynx removed due to cancer, this tube can be inserted into the permanent stoma

Tracheotomy

Procedure of establishing access to trachea via neck incision


:either traditional surgical tracheotomy or percutaneous dilatational tracheotomy can be performed


Opening in neck is called "tracheostomy"



Tracheotomy Procedure is best performed by physician or surgeon after patients airway is stabilized(which means patent and secured by an endotracheal tube)


Selection of trachesotomy tubes depend on


:patients age


:height


:weight


:airway anatomy

Tracheotomy

If patient is doing fine on ETT tube and will be able to be extubated within 14 days, continue with ETT tube and extubate after. If patient needs more than that, then tracheotomy is suggested

the primary indications for an artificial tracheal airway include all the following, except

Provide negative pressure ventilation

Types of trach tubes

Cuffed trach tubes


Double cannula trach tubes


Single cannula trach tues


Fenestrated trach tubes


Cuffed trach tube

Cuffed


:provide seal between upper and lower airway to prevent aspiration of food or secretions


:Maintain a seal during mechanical ventilation


Double cannula trach tube

Outer cannula


Inner cannula


Obturator aids insertion of the outter cannula


Cuff


Pilot balloon


Single Cannula trach tube

Single cannula


:appropriate for permanent trach


:patients with minimal secretions


Pediatric patients


Airway maintenance

Role of RTs


:secure tube and maintain placement


:provide for patient communication


:for the patient to be able to speak, the cuff must be deflated when using a trachestomy tube


:ensure adequate humidification


:minimize possibility of infection (sterile and asepsis)


:Aide in secretion clearance


:Provide appropriate cuff care


:Troubleshoot airway related problems


Airway maintenance

Tracheostomy care


:Step 1: assemble and check equipment


:Step 2 explain procedure to patient


:Step 3 suction patient


:Step 4 remove and replace inner cannula(not clean its disposable)


:Step 5 clean and examine the stoma site (saline or hydrogen peroxide)



Fenestrated tracheostomy tube

Has holes prior to the cuff then the tip(end of the tube)

Parts of the tracheostomy tube

1. Out cannula: keeps stoma open


2. Inner cannula: can be removed for cleaning


3. obturator: used to insert outer cannula


4. Cuff seals airway


5. Plug (button) keeps air from OC(outter cannula) when fenestration is used