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Resp 2.6 II
Airway management pp
| Question | Answer |
|---|---|
| Tracheotomy | an incision into. The procedure establishing access to the trachea |
| Tracheostomy | forming a new opening. The opening created by the tracheotomy procedure |
| stoma | hole in trachea without tube in place |
| tracheostenosis | narrowing of the lumen of the trachea |
| tracheal granumola | caused by abrasion of tube tip or at the stoma site |
| TE fistula | hole between the trachea and the esophagus |
| Tracheomalacia | softening of the tracheal cartilage |
| Why would you choose a trach | Pt needed artificial airway more than 7-10 days, pt tolerance for ET tube, pt ability to tolerate surgery, relative risks of continuing ET tube |
| When is the incision | collar incision 2 cm from the suprasternal notch; incision through the 2nd and 3rd tracheal rings |
| On x ray where is trach tip | 4-6 cm above carina |
| Complications of trach | bleeding, pneumothorax, air embolism, subcutaneous emphysema....Late complications: infection, hemorrhage, tracheal stenosis |
| How to minimize infection | use sterile technique during suction, wash hands etc,, and regular change of dressing |
| Advantages of trach tubes | long term, more comfortable, less movement in trachea, allows speaking and eating, more efficient suctioning, resistance to airflow is less because it is wider, shorter and less curved |
| What is the shiley | weaning tool; has fenestration (hold in outer cannula only), this forces the pt to ventilate through fenestration and around tube |
| How to use fenestrator or shiley | when inner cannula is removed you deflate cuff and cap outer cannula |
| Problems with shiley | possible formation of granular tissue at fenestration site (tissue plugs up the hole) |
| What does the Spiral wire embedded tube do | help prevents bending and kinking |
| What is the Jackson | metal tube for long term use, no cuff |
| Fenestrated tube | hole located at curve of outer cannula, the purpose is to allow pt to try breathing without the use of tube (remove inner cannula) |
| Foam cuff (Bivona) | cuff inflates when exposed to room air, not when air is added to pilot tube |
| Lanz tube | has pressure relief valve in pilot, releases pressure when it exceeds limit.... It automatically maintains intracuff pressure at 30 cmH20 to help reduce the risk of tracheal damage during long term intubations |
| Pitt | speaking tube allows pt to speak while on ventilator with cuff inflated |
| What does the Pitt look like | 2 thin tubes attached to trach tube, one for cuff and one to be occluded forcing air up over vocal cords... The end of line occluded to create speech is attached to gas source (flowmeter) (cuff stays inflated) |
| Passy- Muir speaking valve | one way valve attaches to the 15 mm adaptor, allows for speech and secretion management |
| how does passy muir work | Its a one way valve that allows air only during inspiration Blue-colored used with vents....White spontanously breathing, shorter tube |
| Trach button | aid in weaning from trach tube. It keeps stoma open. It extends from skin to just insdide the tracheal wall. |
| What does trach button look like | short, soft hollow tube which firts in stoma in place of trach tube |
| Olympic tracheostomy button | hard plastic device that keeps stoma open, does not bend and does not have cuff, does not maintain closed circuit therefore mechanical ventilation is not possible. (one way valve for speech) |
| If pt is on vent and needs trach care (cleaning) | remove inner cannula and re insert clean tube as fast as possible! Hit alarm silence on vent |
| When will you do a tracheostomy change out | When you need a new one, when pt's condition is unstable, edema around site that may make change difficult |
| Methods for weaning from tracheostomy tube | Tracheostomy buttons, fenestrated tubes, progressively smaller trach tubes |
| What is the laryngeal mask airway | hollow tube with a spoon shaped mask. The mask has a cuff attached to the end of it which inflates to permit the area around the tracheal glottis and epiglottis to be sealed. It sits on the esophageal sphincter |
| what is the biggest problem with the LMA | regurgitation during insertion |
| What are the indications for LMA | when intubation is difficult or mask is difficult when using bag, pt who fears vocal cord damage, resp arrest, elective surgery or bronchoscopy |
| Hazards of LMA | pt with full stomach (aspiration risk), it may leak if ventilating pressure is greater than 20 cmH20 |
| Esophageal tracheal combitude | 2 tubes in 1 that will operate as a functional airway device regardless of whether the tube is inserted into the esophagus or trachea |
| Indications for ETC | unconscious, apneic adults, Cspine injury, lack of equipment |
| Advantages of ETC | minimal training, airway regardless of location, |
| Disadvantages of ETC | if inserted to far, the pharyngeal balloon can obstruct the glottis |
| What is the most common causes of airway obstruction | tube obstruction |
| What are the causes of airway obstruction | kinking of tube, herniation of cuff over tube tip, jamming of tube orifice against tracheal wall, mucous plugging |
| How do you know there is an obstruction | peak airway pressure on ventilator increase, decreased breath sounds, decreased airflow through tube |
| How do you know if there is COMPLETE obstruction | resp distress, no breath sounds, no gas trough tube |
| If kinked/jammed tube what do you do | move head slightly |
| If potential herniation what do you do | deflate cuff |
| If obstruction is in tube | remove inner cannula |
| When will you need to remove entire airway and replace it? | if all the methods are not working |
| On x ray where should trach tube be | 4-6 cm above the carina |
Created by:
TnJFarrington12
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