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Tracheostomy

how often is the trach tubAnswer
How often is the trach tube changed? Every 8 weeks
How often will staff record the routine trach change? Everytime it is done
How many staff must be present during trach change? 2 staff members must be present and both must have their trach/suction skill
How often is the inner cannula replaced? It is replaced every morning and evening.
Before starting the procedure.. Make sure that you have all materials before starting
Before you do the trach change always... remove the dressing
Always remove the trach dressing before? Changing the inner cannula
What kind of procedure is trach changing? Trach changing is a clean procedure, always wear gloves while doing it.
1 staff member must hold the phlange during trach change, and one staff member does the? Inner cannula while the other staff member is holding the phlange.
When cleaning the trach stoma.. always use the applicator, swabbing from the center of the trach, to the outside. (ensuring dirt and debris is removed efficiently)
How much saline should be used for instillation? 1-2 mls of saline is required for instillation
What should you do if the patient needs ventolin for respiratory symptoms? Call the nurse and give them a heads up.
What is the MDI? Medication Dose Inhalation(adapter)
Where are all inhalers given? In the MDI adapter
When is the inhaler medication given? After exhalation, administer 3 puffs, then after the next exhalation administer 3 more.
How often should you suction the patient? suctioning is done PRN (as needed) to remove congestion or a mucous plug
What kind of procedure is suctioning? Clean, this means we glove up!
How often is the trach dressing changed? In the morning
The trach stoma is cleansed with? normal saline
What supplies would you need to change the trach dressing? Saline, clean trach dressing, q-tip applicator
When are trach ties/posey replaced? Bi weekly, following a hairwashing or bath, or if it becomes soiled.
How tight should the posey be on both sides of the neck? 2 finger width on each side
When would you chart in the trach tube/ vent chart? after changing ties or posey
How often are trach instillations done? PRN
How are trach instillations done? 1-2 mls of normal saline into the stronghold suction port (what holds the vent into the trach)
Would you suction after instillation? Yes, suctioning after instillation is always required, even if there is a cough and clearing present
How often are pulse and O2 saturations taken? Every four hours or once per shift.
Make sure that vitals are recorded.. Everytime they are taken
Report to the nurse if O2 saturations are less than.. 90%, Or if there is any abnormal reading
If the trach comes out partially.. gently push it back in
If the trach comes out completely? Replace it with a new one
Always use a.... Cuffless trach
What size trach is required for the patient? Shiley #6
If a Shiley # 6 will not work, use a.. Shiley #4
Cuffed trachs are for? Emergency personel only!
Why is the stronghold attached to the phlange? to secure the trach from coming out
How often is the stronghold replaced? PRN ( as needed)
If the patient is seen to be struggling or uncomfortable... Check all equiptment, starting proximal (closest to) patient, then work your way to the ventilator. Check all tubes, ports, circuts and connectors.
What size suction catheter is used for suctioning the trach? #14 suction catheter
How would you check to see that the suction machine is working? suction a small amount of saline through the catheter
The suction machine is always set to? 150mm Hg
Where is suctioning conducted? In the suctioning port in the stronghold.
How far do you insert the suctioning catheter into the suctioning port? Until resistance is met
After you feel that resistance has been met, what is your next step? Withdrawl the suction catheter 1 cm and provide intermitten suctioning
Always discard the suction catheter? Once a day
After changing the catheter.. time and date the new catheter package
Oral suctioning is done with a? Yaunker catheter
Vitals as taken.. once per shift
If patient is still de stating and all equiptment is intact and functioning.. remove the inner cannula to assure it is not plugged, suction, administer a bronchodialator, check O2 sats, if all else fails call the nurse, may have to use ambu bag
How many respirations per min is the patients ventilator set at? 14 respirations per minute
The patients head should be at? 30 degrees or greater at all times
How often should chlorhexidine mouth rinses be done? q12 hours every 12 hours
Mouth care is done every? q4 hours
Why is mouth care done every 4 hours? to prevent ventilator associated pneumonia
Alarms will go off if there is? High pressure ( any condition that increases resistance in air flow)
What should you do if there is a high pressure alarm? suction, relieve symptoms with ventolin puffers at MDI port,check for kinks or water accumulation in the circut or HME filter, change inner cannula if high pressure continues call nurse
When will the alarm go off for a high pressure trigger? When the pressure is 60 and above
When will the low pressure alarm be triggered? When pressure is 15 or below
When the low pressure alarm sounds what steps should you take to ensure it goes back up? make sure that the inner cannula is not lose,check all tubing and circuts for detachment, reconnect patient to vent, check for correct tubing, check for disconnections and or leaks
In the event of a power failure alarm... make sure that the ventilator is plugged into the red socketed wall plug, and that the vent is running off an internal battery
Call the on call nurse if? The generator must be used
When there is a power failure what steps must you take to ensure you patient is breathing? make sure that the vent has switched over to battery power and then turn on the generator.
Where is the generator located? on the concrete patio at the back of the house, near exit of staff restroom
How would you turn the generator on? lift up top cover of generator, press blue manual start button, then close the cover and proceed to the mechanical room (located down concrete stairs to carport area)
Where is the mechanical room located? To the right is a doorway to the mechanical room, proceed to the panel at the back wall.
When you get to the back panel at the back of the room what should you do? Push HYDRO switch down, slide bar to the left, push STANDBY switch up.
How would you turn the generator off? Go to the mechanical room and switch the STANDBY switch down, slide the bar to the right, push HYDRO switch up, then go to the generator, wait a few mins and lift the cover and push the STOP button
What happens if the generator is not working? Go to another ARCUS home, you can also call a wheel chair taxi or an ambulence
When the ventilator alarms always check if the patient is... In distress, check the ventilator system connections, also check for water in the patients HME filter or in the tubing
The HME should be what side up? Spongy side up
What should be written on the HME filter? The date and time changed
Make sure that the stronghold is always in place so that it can stay connected to what? The trach that gives air to the patient.
The exhalation valve must never be blocked. What are some examples of things that would block this exhalation valve? Blankets
How often is the staff supposed to fill out the Legendaire/560 ventilator flowesheet? q8 hours ie every 4 hours if ill
How often is the flex tubing changed? q weekly, Tuesday or Wednesday (same day as HME)
MDI is changed how often? q weekly same day as HME
Change the HME filter how often? q 48 hours write time and date on the spongy side up side
How often should the circuit be changed? q 2 months when the trach change is done ( must bring 2 circuts at trach change)
How often is the filter changed on the back of the ventilator? PRN as needed
Staff must document what in the trach change record? When the flex tubing, HME, MDI, Circuit/trach is changed
Flex tube and MDI can be... washed with warm, soapy water if you ever run out
Staff should familiarize themselves with patients emergency equiptment contents every? q shift
The emergency equiptment will go with the patient when? They leave
Name emergency equiptment and supplies that must go with the patient when they leave? Manual resuscitator/ambu bag with flex hose, portable oxygen, spare #6 Shiley trach tube, cuffed and cuffless and a small size Shiley #4, spare inner cannula, trach posey/ties, stronghold,syringe and tubing (if no power), emergency circuit, gloves
Name more emergency equiptment that must go with the patient when they leave... #14 suction catheter for trach suctioning, yaunker suction cath (oral), saline nebules, suction machine (fully charged) attached with saline , PRNs, back up power source, drain sponge, oxygen adapter for venttilator.
Created by: sarahschester