| 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. |
