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ARTP > 06: Tracheostomies > Flashcards

06: Tracheostomies Flashcards

1
Q

Where is the trach incision made?

A

Below larynx, through 2nd and 3rd cartilage ring (one finger below cricoid)

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2
Q

-otomy

A

Incision into

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3
Q

-ostomy

A

Forming a new opening

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4
Q

Stoma

A

Hole in trachea without tube in place

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5
Q

Advantages of trach v ETT

A

Long term
More comfortable for pt
Less intratracheal movement
Speaking/eating
More efficient suctioning
Less Raw
Shorter weaning
Less sedation

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6
Q

Primary indication for trach

A

Projected 10-14 days pt needing artificial airway/vent support

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7
Q

Other indications for trach

A

Suctioning efficiency
Bypass upper aw obstruction
Vocal cord paralysis
Tracheal instability

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8
Q

Parts of trach tube

A

Outer cannula (radiopaque line)
Inner cannula (15mm)
Flange
Obturator
Cuff
Inflation pilot balloon
Trach ties

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9
Q

Locking reusable inner cannula

A

End rotated to remove/secure

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10
Q

Disposable inner cannula (DIC)

A

Tabs squeezed for removal/placement

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11
Q

Obturator must always be left

A

At bedside

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12
Q

Obturator

A

Minimizes trauma to tracheal mucosa during insertion
Only used to put outer cannula in stoma

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13
Q

Trach sizing

A

ID
6.0-8.0

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14
Q

Percutaneous dilation placement (perc trach)

A

At bedside
Reduced cost
Pt must be able to tolerate a large leak around ETT for duration of procedure

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15
Q

Post trach placement assessment

A

4-6 cm above carina
Vitals/ventilation
Palpate for subq emphysema
Ensure holder secure

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16
Q

Proper cuff pressure measurements

A

15-25 mmHg
20-30 cmH2O

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17
Q

Cuff pressure increasing when using the same volume of air?

A

Edema at tracheal cuff site

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18
Q

Tracheostomy complications

A

Tracheal stenosis
Tracheomalacia
Tracheal granulomas
Tracheoesophageal fistula
Tracheoinnominate artery fistula

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19
Q

Tracheal stenosis

A

Narrowing of the lumen of trachea associated w fibrous scarring

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20
Q

Tracheomalacia

A

Softening of tracheal cartilage
Causing collapse of trachea during inspiration

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21
Q

Tracheal granuloma

A

Abrasion of tube tip at stoma site

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22
Q

TE fistula

A

Hole between trachea and esophagus to due tracheal erosion

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23
Q

Minimizing infection of stoma

A

Sterile technique
Regular aseptic cleaning
Q8

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24
Q

Hydrogen peroxide is used to clean only the

A

Inner cannula

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25
Q

How to prevent tracheal stenosis

A

Maintain correct position, trach holder tension, and cuff pressure

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26
Q

Three options for weaning trach

A

Red cap, fenestrated tube, gradual smaller sizes

27
Q

Maintain/prevent infection in stoma

A

Disposable IC: changed daily
Sterile technique
Regular aseptic cleaning
Q8/PRN

28
Q

Bedside percutaneus trach advantages

A

Decreased cost
No transport
**pt must be able to tolerate large leak

29
Q

Fenestrated trach tubes

A

Weaning

30
Q

How to test upper aw function with fenestrated trach tube

A

Remove IC
Deflate cuff
Place cap

31
Q

Hi-lo eval cuff pressure number and continuous suction number

A

40 cmH2O
-20 mmHg

32
Q

Jackson metal trach

A

Long term use

33
Q

Bivona foam cuff

A

NOT for weaning
Long term care
Fills with ambient pressure

34
Q

Bivona TTS

A

Sterile water
Single cannula
Weaning

35
Q

Single cannula trachs

A

Pediatrics/long-term ventilation

36
Q

XLT trach

A

No MRI
Temporary
Obesity
Adjustable neck flange

37
Q

How often to change out trach

A

Monthly

38
Q

When do therapists not perform trach change out

A

Trach is <5 days old
Pt unstable
Edema

39
Q

Cuffless

A

Kids

40
Q

Decannulation assessment

A

Adequate cough
No active infection
Reduced secretions
Patent upper aw
Adequate swallow

41
Q

Passy-Muir speaking valve

A

One way valve
Closes on exhalation

42
Q

Ways to communicate

A

Lip reading
Written communication
Letter/phrase/picture board
Cell phone
Speaking valve

43
Q

Way to communicate with artificial larynx

A

Electrolarynx

44
Q

1 indication for laryngectomy

A

Laryngeal cancer

45
Q

Total laryngectomy

A

No direct access to trachea via mouth, nose, or upper aw

46
Q

Partial laryngectomy

A

May be access to lungs via upper aws

47
Q

Displacing the tongue

A

Sniffing position

48
Q

Jaw thrust

A

Use w suspected injury to c spine

49
Q

Chin lift

A

Does not extend c spine

50
Q

LMA characterisitics

A

Inserted blindly
Low pressure seal (vent pressure >20cmH2O)

51
Q

LMA indications

A

Difficult intubation
Poor mask fit (BVM)
Elective surgeries w no aspiration risk

52
Q

LMA contraindications

A

> 14-16 wks pregnant
GERD
OP/abdominal surgery
Prone/obesity
Conscious

53
Q

LMA no chest rise?

A

Reposition

54
Q

King airway indications

A

Unconscious/Apneic pts
Short-term ventilation

55
Q

King airway characteristics

A

No interruption of CPR
Little/no spinal movement
**must be placed in esophagus

56
Q

King airway contraindications

A

Responsive patients (gag reflex)
Esophagageal varicose/disease/trauma
Caustic substance ingestion
Obstructed aw

57
Q

King airway insertion

A

Tongue-jaw lift (neutral head)
Sniffing unless C spine injury

58
Q

Combo tube descriptions

A

Functional aw regardless of placement in trachea or esophagus

59
Q

Combitube insertion

A

Blind

60
Q

Combitube indications

A

Unconscious/apneic adults
Difficult intubation
C spine injury
Bleed

61
Q

Combitube contraindications

A

Children
Aspiration/regurgitation

62
Q

Combitube insertion checking/method

A

1 (blue/tall) first, check for BS, then #2 (clear/small)

No BS: retract 2cm

63
Q

Double-Lumen Endotracheal Tube

A

Right and left lung to be ventilated separately

64
Q

Cricothyroidotomy

A

Incision through cricothyroid membrane

ARTP (9 decks)

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