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Airway Care

Indications And Advantages Preferred method of providing an airway for patients who require long-term ventilation When upper airway is obstructed that prevents intubation
Indications And Advantages: Not an emergency should be done in a sterile condition with the patient intubated. ET tube is removed ONLY as trach tube is inserted
Indications And Advantages: Inner Cannula can be leaned by brushing or rinsing with hydrogen peroxide
Indications And Advantages Patient is able to eat and even speak with tracheal speaking device
Complications of Tracheostomy Immediate Within 24 Hours *Bleeding (major hazard) *Pneumothorax * Air Embolism * Subcutaneous emphysema
Complications of Tracheostomy Late: (24- 48 Hours) * Infection *Hemorrhage *Obstruction * T-E fistula
Tracheostomy Cuff Inflation Always inflated when eating positive pressure ventilation
Tracheostomy Care Cuff Obstructed cuff should be changed if: cuff is obstructed unable to pass a catheter you must ventilate, remove tube, ventilate, and insert new tube
Tracheostomy Care Tube Too Small Very high cuff pressure (>20mmHg) needed to seal the cuff Change To Larger Tube
Tracheostomy Care Punctured Cuff Unable To seal cuff Replace the tube(if seal required)
Tracheostomy Care After Removal of Tracheostomy Tube *Do not suture the stoma closed * Apply sterile dressing and/or antibiotic to site * Clean periodically with hydrogen peroxide * Have patient to cough to clear secretions
Tracheostomy Tubes Standard Trach Tube, Fenestrated Tube, Tracheal Button, Extended Trach Tube, Jackson Trach Tube, Bivona ( Kamen-Wilikinson), Tracheal Speaking Devices
Fenestrated Tube has an opening used for weaning and temporary mechanical ventilation Not for emergencies plugging tube- deflate the cuff, remove inner cannula, then plug tracheostomy Allow patient to breathe through upper airway and speak
Tracheal Button * To maintain stoma * used for patients with Sleep Apnea * Allows tracheal suction and phonation with least amount of airway resistance * Uncuffed, cannot be utilized for resuscitation
Extended Trach Tube * adjustable flanges that allow adjustments of horizontal distance. * Indicated for patients who are obese or use cervical collars
Jackson Trach Tube * Metal trach tube * Comes with an inner cannula * Not for resuscitation
Bivona ( Kamen-Wilikinson) * Must evacuated air prior to use * Air must be evacuated to extubate * Has no inner cannula * Does not have a pilot balloon
Tracheal Speaking Devices Has a One- Way speaking valve cuff must be deflated
Perform Tracheostomy Care Step: 1 Assemble and check equipment
Perform Tracheostomy Care Step: 2 Explain the procedure to the patient
Perform Tracheostomy Care Step: 3 Suction the patient to ensure airway patent
Perform Tracheostomy Care Step: 4 Clean the inner cannula by soaking it in a solution of hydrogen peroxide and water, and rinse with sterile water
Perform Tracheostomy Care Step: 5 Clean the stoma site using cotton applications dipped in the hydrogen peroxide solution, replace gauze dressing
Perform Tracheostomy Care Step: 6 Change trach Tube
Perform Tracheostomy Care Step: 7 Replace inner cannula
Perform Tracheostomy Care Step: 8 Reassess the patient and record the procedure.
Created by: sukarieh