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Tracheostomy
Airway Care
| Term | Definition |
|---|---|
| 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
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