Tracheostomy
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| How often is the trach tube changed? | Every 8 weeks
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| How often will staff record the routine trach change? | Everytime it is done
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| How many staff must be present during trach change? | 2 staff members must be present and both must have their trach/suction skill
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| How often is the inner cannula replaced? | It is replaced every morning and evening.
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| Before starting the procedure.. | Make sure that you have all materials before starting
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| Before you do the trach change always... | remove the dressing
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| Always remove the trach dressing before? | Changing the inner cannula
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| What kind of procedure is trach changing? | Trach changing is a clean procedure, always wear gloves while doing it.
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| 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.
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| 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)
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| How much saline should be used for instillation? | 1-2 mls of saline is required for instillation
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| What should you do if the patient needs ventolin for respiratory symptoms? | Call the nurse and give them a heads up.
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| What is the MDI? | Medication Dose Inhalation(adapter)
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| Where are all inhalers given? | In the MDI adapter
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| When is the inhaler medication given? | After exhalation, administer 3 puffs, then after the next exhalation administer 3 more.
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| How often should you suction the patient? | suctioning is done PRN (as needed) to remove congestion or a mucous plug
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| What kind of procedure is suctioning? | Clean, this means we glove up!
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| How often is the trach dressing changed? | In the morning
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| The trach stoma is cleansed with? | normal saline
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| What supplies would you need to change the trach dressing? | Saline, clean trach dressing, q-tip applicator
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| When are trach ties/posey replaced? | Bi weekly, following a hairwashing or bath, or if it becomes soiled.
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| How tight should the posey be on both sides of the neck? | 2 finger width on each side
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| When would you chart in the trach tube/ vent chart? | after changing ties or posey
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| How often are trach instillations done? | PRN
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| How are trach instillations done? | 1-2 mls of normal saline into the stronghold suction port (what holds the vent into the trach)
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| Would you suction after instillation? | Yes, suctioning after instillation is always required, even if there is a cough and clearing present
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| How often are pulse and O2 saturations taken? | Every four hours or once per shift.
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| Make sure that vitals are recorded.. | Everytime they are taken
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| Report to the nurse if O2 saturations are less than.. | 90%, Or if there is any abnormal reading
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| If the trach comes out partially.. | gently push it back in
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| If the trach comes out completely? | Replace it with a new one
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| Always use a.... | Cuffless trach
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| What size trach is required for the patient? | Shiley #6
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| If a Shiley # 6 will not work, use a.. | Shiley #4
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| Cuffed trachs are for? | Emergency personel only!
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| Why is the stronghold attached to the phlange? | to secure the trach from coming out
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| How often is the stronghold replaced? | PRN ( as needed)
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| 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.
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| What size suction catheter is used for suctioning the trach? | #14 suction catheter
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| How would you check to see that the suction machine is working? | suction a small amount of saline through the catheter
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| The suction machine is always set to? | 150mm Hg
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| Where is suctioning conducted? | In the suctioning port in the stronghold.
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| How far do you insert the suctioning catheter into the suctioning port? | Until resistance is met
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| After you feel that resistance has been met, what is your next step? | Withdrawl the suction catheter 1 cm and provide intermitten suctioning
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| Always discard the suction catheter? | Once a day
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| After changing the catheter.. | time and date the new catheter package
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| Oral suctioning is done with a? | Yaunker catheter
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| Vitals as taken.. | once per shift
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| 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
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| How many respirations per min is the patients ventilator set at? | 14 respirations per minute
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| The patients head should be at? | 30 degrees or greater at all times
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| How often should chlorhexidine mouth rinses be done? | q12 hours every 12 hours
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| Mouth care is done every? | q4 hours
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| Why is mouth care done every 4 hours? | to prevent ventilator associated pneumonia
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| Alarms will go off if there is? | High pressure ( any condition that increases resistance in air flow)
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| 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
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| When will the alarm go off for a high pressure trigger? | When the pressure is 60 and above
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| When will the low pressure alarm be triggered? | When pressure is 15 or below
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| 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
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| 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
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| Call the on call nurse if? | The generator must be used
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| 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.
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| Where is the generator located? | on the concrete patio at the back of the house, near exit of staff restroom
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| 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)
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| Where is the mechanical room located? | To the right is a doorway to the mechanical room, proceed to the panel at the back wall.
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| 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.
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| 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
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| What happens if the generator is not working? | Go to another ARCUS home, you can also call a wheel chair taxi or an ambulence
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| 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
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| The HME should be what side up? | Spongy side up
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| What should be written on the HME filter? | The date and time changed
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| 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.
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| The exhalation valve must never be blocked. What are some examples of things that would block this exhalation valve? | Blankets
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| How often is the staff supposed to fill out the Legendaire/560 ventilator flowesheet? | q8 hours ie every 4 hours if ill
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| How often is the flex tubing changed? | q weekly, Tuesday or Wednesday (same day as HME)
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| MDI is changed how often? | q weekly same day as HME
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| Change the HME filter how often? | q 48 hours write time and date on the spongy side up side
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| How often should the circuit be changed? | q 2 months when the trach change is done ( must bring 2 circuts at trach change)
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| How often is the filter changed on the back of the ventilator? | PRN as needed
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| Staff must document what in the trach change record? | When the flex tubing, HME, MDI, Circuit/trach is changed
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| Flex tube and MDI can be... | washed with warm, soapy water if you ever run out
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| Staff should familiarize themselves with patients emergency equiptment contents every? | q shift
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| The emergency equiptment will go with the patient when? | They leave
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| 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
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| 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.
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Created by:
sarahschester
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