| Question | Answer |
| What is a Tracheotomy? | The surgical incision into the trachea to establish an air way. |
| What is a Tracheostomy? | The Stoma the occurs from the tracheotomy. |
| Where does the tracheotomy occur on the trachea? | 2nd and 3rd tracheal rings. |
| What is a Permanent Tracheosotmy called? | Total laryngectomy. |
| What are the 3 main components of Tracheosotmies? | Outer Cannula, Inner Cannula, Obturator |
| What is the purpose of the Obturator? | To occlude the airway, it fits inside the outer cannula. |
| What type of Tracheosotmy (cuffed or uncuffed) prevents aspiration and air leakage? | Cuffed Tracheostomy |
| What type of Tracheostomy (cuffed or uncuffed) is used for long term trach care and reduces the risk of tracheal-esophageal fistulas? | Uncuffed Tracheostomy |
| Do children require cuffed tubes? Why or Why not? | No, because their trachea is elastic and it stretches to prevent leakage. |
| What type of tracheostomy (cuffed or uncuffed) has an increase risk for aspiration compounded by G-tube feedings? | Uncuffed |
| What type of tracheostomy (cuffed or uncuffed) must the HOB be elevated at all times? | Uncuffed |
| What must the inflated cuff pressure not exceed? | 20mm Hg |
| What is the risk of the Minimal Leak Technique in Cuffed Tracheostomy Tubes? | Risk of Aspiration |
| Describe the Minimal Leak Technique in Cuffed Tracheostomy Tubes? | Inflate cuff w/ minimum air for a seal, then withdraw 0.1 mL or air? |
| How are retention sutures unlike regular sutures? | Retention sutures go deep into the tissues (ie. tracheal cartilage) |
| What is the purpose of retention sutures in Tracheostomies? | To help keep the airway open. |
| What must be kept at bedside for tracheostomy patients? | Replacement tubes and obturator. |
| When should trach tapes be changed after insertion surgery? | Not before 24 hours. |
| What should a nurse do in the case a pt's trach tube becomes dislodged? | Don't leave room, Activate Rapid Response Team, try to replace tube, hold retention sutures open |
| If a pt's trach tube becomes dislodged, how should the nurse try to replace it? | Lubricate tip w/ saline, INSERT at 45 degree angle, remove obturator |
| Since air is no longer filtered or humidifed when breathing through a trach tube, what can be done to provide the pt with some comfort in regards to the dry air and secretions? | Mist collar |
| After the 1st trach tube is changed, how often should it be changed? | Monthly |
| What type of health professional evaluates a trach tube pt's risk for aspiration? | a Speech Therapist |
| What is the purpose of a Fenestrated Tracheostomy? | To allow the pt to speak by allowing air to pass over the vocal cords. |
| What is a potential complication of using a Fenestrated Tracheostomy? | Tracheal polyps |
| What should be assessed in a pt with a Fenestrated Tracheostomy? | Ability to swallow before use and Signs of Respiratory distress on the first use. |
| Does the Fenestrated Tracheostomy have an inflated or deflated cuff? | Deflated cuff |
| How do Speaking Tracheostomy tubes allow the pt to talk? | By using an inflated cuff to speech. |
| Name a Speaking Tracheostomy Valve. | Passy-Muir Valve |
| What does a Passy-Muir Valve require? | Cuffless tube or deflated cuff |
| How does a nurse evaluate a trach pt's ability to tolerate cuff deflation w/o aspiration or respiratory distress? | Listen to lungs/breathing effort, continuous pulse oximetry, check for cyanosis |
| How often should routine trach care be performed? | Every 4 hours |
| What is the purpose of suctioning a trach pt? | To maintain a patent airway and to remove accumulate respiratory secretions. |
| What situation does a pt need suctioning? | ↓ LOC, ↓ ability to cough, obstructive upper airway, facial/neck trauma or surgery |
| What causes accumulated respiratory secretions? | ↓ ability to cough and ↓ LOC |
| Can trach suctioning be done in a non-sterile method? | No, it must be STERILE |
| Should oral and oropharangeal suctioning be conducted in a sterile method? | No, it is a non sterile procedure |
| What type of catheter should be used for oral/oropharyngeal suctioning? | Yankauer catheter aka. Tonsilar Tip |
| What type of suctioning procedure requires a sterile technique? | Nasotracheal suctioning |
| How often should the Yankauer catheter (tonsilar tip) be changed? | Every 24 hours and prn. |
| What are some risks related to artificial airways and their suctioning? | Hypotension, hypertension, ↑ICP, dysrhythmia's, nosocomial infection |
| What are some signs/symptoms that may indicate a need for suctioning? | Gurgling, coughing, at pt request, ↓ respiratory rate |
| Why should a pt be well hydrated during suctioning? | For easy removal and to loosen mucus. |
| What size should the suctioning catheter be? | 14-16 Fr or 1/2 the diameter of the outer cannula. |
| When is a suctioning of ? 120mm Hg ok to use? | During ORAL suctioning. |
| What is the appropriate suctioning pressure for tracheal suctioning? | 80-120 mm Hg |
| Why should suctioning not be applied when inserting the catheter? | Trauma of the tissue lining may occur. |
| What is the maximum amount of suctioning for intermittent/continuous suctioning? | Max of 10 seconds at a time. |
| Can you suction when withdrawing the catheter? | Yes, suction should occur when withdrawing the catheter. |
| How and when should Hyperoxygenation occur? | Before and between suctioning with 100% oxygen. |
| What type of systems can be used to Hyperoxygenate a pt? | Ambu bag |
| How how much oxygen should be delivered via an Ambu bag during Hyperoxygenation? | 12-15 L/min giving 3-5 breaths |
| How should a pt be hyperoxygenated if they are on a ventilator? | 100% oxygen for 2 minutes. |
| When should you not hyperoxygenate with an Ambu bag? | If copious secretions are present because they force secretions back down the trachea. |
