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RCP111
Tracheostomy Tubes
| Question | Answer |
|---|---|
| What is a tracheostomy? | the procedure of establishing access to the trachea via neck incision. |
| What is the opening in the neck called? | tracheostomy |
| Tracheostomy procedure is best performed by? | surgeon in the surgical setting |
| What are the indications for a tracheostomy? | - protocol for trach over endotracheal tube: - long mechanical ventilation with a trach (10-14 days) - complete airway obstruction - patent airway when ET tube contraindicated - frequent aspiration - need to decrease anatomical deadspace |
| What are some complications? | - displacement or decannulation - Infection - Tracheal lesions |
| What is displacement or decannulation? | - fresh trach vs established trach - stabilization during care - pt cough or movement |
| What is tracheal lesons? | - tracheostenosis - tracheomalacia - T-E fistula |
| What are the characteristics of a trach? | - Made of non- PVC material or silicone. - 15mm connector at the flange (neck plate). - Commerical secure device or twill tape for securing tube or neck. - Inner diameter measured in mm. - Should meet Z79 IT standards. |
| What are the Z79 IT standards? | American Nat'l stds Institute (ANSI) requires specific cell testing for human toxicity. |
| Descriptions of Tubes: | - Cuffed or Non- cuffed. - Double- cuffed. - Extra- Long. - Inner Cannula or without Inner Cannula. - Fenestrated. - Metal (Jackson)- made of stainless steel. - Laryngetomy Tubes- Partial or Total. |
| What are some fenestrated Trach Tube Facts? | - Used for weaning from trach by allowing pt to breathe through upper airway. - MUST deflate cuff and remove inner cannula. |
| Jackson (Holinger) metal trach. | - Non- disposable, cuffless. - Removable inner cannula. - Obturator- for easy insertion. - Primary for long term use. - Can be used to decrease stoma size. |
| What some ways to trouble shoot an airway in emergencies? Tube Obstruction | - Kinking or biting (ETT) the tube. - Herniation of the cuff over the tip. - Jamming of the tube orifice against the tracheal wall. - Mucus plugging. |
| How to assessing patency of a trach tube? | - Feel and listen for airflow from tube. - Attempt to pass suction catheter. - Attempt to manually ventilate. |
| What are some of the specialized trach devices? (these allow the pt to talk) | - Communi- Trach (Pitt Speaking Tube). - Tracheostomy Button. - Olympic Trach- Talk - Passy- muir valve. |
| What is a Communi- Trach? | - Allows for speech. - Fenestrated. - Used with low flow air or O2.: - pt can not produce enough flow through cords. - Can be used with cuff inflated or deflated, but must remove inner cannula. |
| Kistner Button Facts: | - Helps with talking and coughing. - One- wat valve opens on inhalation and closes on exhalation. |
| Olympic Trach talk | Similar to Kistner, use with cuff deflated. |
| Passy- Muir Valave Facts: | - Same as previous speaking valve, except uses leaf or diaphragm valve. - As others, use with cuff deflated. - Various models for different situations: - Can be used with mechanical vent. |
| What is the of trach cuffs? | - Still have aspirations and pharyngeal secretions. - Suction tube, then above cuff, (Remember Pouiselle's Law). - Allows for positive pressure vantilation. |
| What is the importance of cuff pressure? | Inflate with syringe through spring- loaded valve on pilot balloon. |
| Importance of cuff pressures, need pressure less than? | 25mmHg |
| What happens if the pressure in the cuff is greater that 30mmHg? | CAUSES: - Loss of blood flow (art, ven, cap). - Loss of lymphatic flow. - Trauma to tracheal wall. |
| What are the two ways to measure cuff pressure? | - Minimal Leak Technique (MLT) - Minimal Occluding Volume (MOV) |
| What are the best strategies to prevent tracheal wall damage? | Use low cuff pressures and choosing correct size tube. |
| How do you measure cuff pressure? | - Manometer - 3- way stopcock. - 10 mL syringe. |
| What is the device measurements acceptable range? | - 20-25mmHg equates to between 24 and 30cmH2O. |
| Most manometers are calibrated in? | - in cmH2O NOT mmHg. |
| 1mmHg equals how much cmH2O? | 1.36 cmH2O. |
| What are the two different types of cuffs? | _ Bivona Foam Cuff. - Lanz Airway Cuff. |
| What is the Bivona Foam cuff? | - Works opposite from other cuffs. - Have to extract air to deflate, or it stays inflated. - Can't measure pressure. - If pilot tube is cut, Can't deflate to remove. |
| What is the Lanz Airway cuff? | - Has pressure controlling pilot balloon. - Trachea squeezes air into cover. - Limits pressure to 20-25mmHg. |
| What are some problems with cuff? | - Deflate cuff completely, then change tube. (tube changer) - Commercial repair kit for pilot balloon. - Use blunt needle. 3-way stopcock, and syringe. |
Created by:
tracyb34
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