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Trach care

What equiptment would you gather for a trach tube change? Suction machine,catheter,oxygen,ambu-bag,new trach tube, smaller trach tube, saline,KY gel,trach ties and gauze.
Do you need an assistant for a trach tube change? Yes, always have an assistant to help you.
How would you prepare the client for a trach tube change? Prepare the client by lying them in bed with their head up and a pillow under their shoulders or sitting up in a wheelchair with the head rest off.
What is used to guide and direct the trach tube? The obturator is used to direct the new trach tube into position.
Where should your assistant stand during the placement of the new trach tube? Your assistant should be standing by your clients head.
Never touch Parts of the tube that will enter the stoma.
How tight should the trach ties be around your clients neck? You should be able to slip two fingers under the posey.
What are the purpose of the trach ties? To hold the trach in place.
Which hand will hold the new trach tube? The dominant hand that will only hold the trach tube
When inserting a new trach tube.. direct it back and downward, like inserting a nozzle of a gas pump on your car.
Do you suction the client before or after a trach change? Before, after the trach change as needed, if the patient coughs
What is a tracheal instillation? A tracheal instilliation is an application of a saline nebule, directly into the tracheal tube that allows secretions to loosen,allowing the patient to cough up or have suctioned out.
When are tracheal instillations usually administered? In the morning upon rising, at bedtime and before suctioning.
How much(volume) saline should be instilled? The decision is based upon a clients age, weight and body size, general size and the consistancy of the secretions.
After instilling the clients tracheal tube, what should you do next? Suctioning, unless client clears secretions with a strong cough
Remember, to allow clients to.. Breathe a few times before suctioning.
Why is important to provide adequate humidity to clients with a trach tube? To provide moisture to loosen secretions so the tube does not get blocked. Also serves to keep the lungs healthy.
Humidity is provided in what three different ways? 1. Room Humidifier. 2. Distilled water in a bottle attached to an oxygen concentrator. 3. Humidivent ( which attaches to the trach tube) (only use when with the client)
How does humidivent work to provide humidity to the trach? This device traps moisture, fliters air and conserves heat.
Humidivent should only be used when supervised, why? They device may become blocked with mucus. Since the client is not able to remove it he/she will be unable to breathe.
When suctioning a trach tube the procedure should take no longer than ? 8-10 seconds
Suctioning should be repeated until? The airway is clear of mucus
How much time should you allow between suctioningand why? 30 seconds, to allow patient to reoxygenate and catch their breath.
Suctioning machine pressure should be adjusted via the patient's.. Age and respiratory condition.
Suctioning machine pressures for a infant should be? 60-80mmHg
Suctioning machine pressures for a child should be? 80-100mmHg
Suctioning machine pressures for a older teen or an adult should be? 80-120mmHg
What equiptment will you need for a tracheal suctioning machine procedure? Suction machine, size appropriate catheter, disposable gloves, bottle of saline to clean catheter and tubing, saline nebule for instillation, and kleenex or gauze.
How far do you insert the suction catheter into the trach tube? 1-2cm beyond the end of the trach tube.
Withdrawl the cath 1/2-1 cm before applying suction to prevent? tracheal trauma
How do you apply suction? By covering the hole with your thumb.
If mucous is bubbling at the opening of the trach tube... Suction that first
Never use the same catheter for ? tracheal suctioning and mouth/nasal suctioning
How often should a catheter be replaced? At least once every 24 hours unless client has a chest infection or requires frequent suctioning.
How often should the water bottle to rinse the catheter be replaced? At the end of every shift.
What are some signs of airway obstruction? Color change, wheezing, not breathing, chest heaving, suction catheter will not pass easily or at all.
What should you do about an airway obstruction? Take out the inner tube to clean out mucous plug, try suctioning after the tube is cleaned and reinserted, if bronchodialater is required administer by fitting nebulizer over trach tube, if symptoms persist provide O2 via trach mask(6-10l per min) or 911
What are some signs of a dislodged trach tube? Trach tube comes out partially, or completely.
What should you do if the tracheal tube becomes dislodged? Stay calm, reinsert the tube if partially out. Replace twith a new tube if completely out abd stay calm.
What are some signs of bleeding? Secretions are light pink, or bright red.
What do you do if there is bleeding present? If the secretions are pink, suction less frequesntly and rotate the catheter more gently. Inform the nurse asap. If the secretions are bright red, stop suctioning and inform nurse immediately.
What are some signs of a chest infection? Noisy breathing, increased coughing, laboured breathing, respiration rate increased, O2 stat decreases below clients normal range, Change in secretions i.e. mucous is thicker and yellow-green and has a odor or is plentiful.
What do you do if there is a chest infection present? Inform the nurse immediately. Provide care as directed by nurse.
What is the ambu-bag used for? is used to provide artificial respiration to a client that has stopped breathing.
Where is the ambu-bag attached, when you have a client with a trach tube? Directly onto the trach tube
Created by: sarahschester