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ARTP > 06: Tracheostomies > Flashcards

06: Tracheostomies Flashcards

(64 cards)

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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
How to prevent tracheal stenosis
Maintain correct position, trach holder tension, and cuff pressure
26
Three options for weaning trach
Red cap, fenestrated tube, gradual smaller sizes
27
Maintain/prevent infection in stoma
Disposable IC: changed daily Sterile technique Regular aseptic cleaning Q8/PRN
28
Bedside percutaneus trach advantages
Decreased cost No transport **pt must be able to tolerate large leak
29
Fenestrated trach tubes
Weaning
30
How to test upper aw function with fenestrated trach tube
Remove IC Deflate cuff Place cap
31
Hi-lo eval cuff pressure number and continuous suction number
40 cmH2O -20 mmHg
32
Jackson metal trach
Long term use
33
Bivona foam cuff
NOT for weaning Long term care Fills with ambient pressure
34
Bivona TTS
Sterile water Single cannula Weaning
35
Single cannula trachs
Pediatrics/long-term ventilation
36
XLT trach
No MRI Temporary Obesity Adjustable neck flange
37
How often to change out trach
Monthly
38
When do therapists not perform trach change out
Trach is <5 days old Pt unstable Edema
39
Cuffless
Kids
40
Decannulation assessment
Adequate cough No active infection Reduced secretions Patent upper aw Adequate swallow
41
Passy-Muir speaking valve
One way valve Closes on exhalation
42
Ways to communicate
Lip reading Written communication Letter/phrase/picture board Cell phone Speaking valve
43
Way to communicate with artificial larynx
Electrolarynx
44
#1 indication for laryngectomy
Laryngeal cancer
45
Total laryngectomy
No direct access to trachea via mouth, nose, or upper aw
46
Partial laryngectomy
May be access to lungs via upper aws
47
Displacing the tongue
Sniffing position
48
Jaw thrust
Use w suspected injury to c spine
49
Chin lift
Does not extend c spine
50
LMA characterisitics
Inserted blindly Low pressure seal (vent pressure >20cmH2O)
51
LMA indications
Difficult intubation Poor mask fit (BVM) Elective surgeries w no aspiration risk
52
LMA contraindications
>14-16 wks pregnant GERD OP/abdominal surgery Prone/obesity Conscious
53
LMA no chest rise?
Reposition
54
King airway indications
Unconscious/Apneic pts Short-term ventilation
55
King airway characteristics
No interruption of CPR Little/no spinal movement **must be placed in esophagus
56
King airway contraindications
Responsive patients (gag reflex) Esophagageal varicose/disease/trauma Caustic substance ingestion Obstructed aw
57
King airway insertion
Tongue-jaw lift (neutral head) Sniffing unless C spine injury
58
Combo tube descriptions
Functional aw regardless of placement in trachea or esophagus
59
Combitube insertion
Blind
60
Combitube indications
Unconscious/apneic adults Difficult intubation C spine injury Bleed
61
Combitube contraindications
Children Aspiration/regurgitation
62
Combitube insertion checking/method
#1 (blue/tall) first, check for BS, then #2 (clear/small) No BS: retract 2cm
63
Double-Lumen Endotracheal Tube
Right and left lung to be ventilated separately
64
Cricothyroidotomy
Incision through cricothyroid membrane

ARTP (9 decks)

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