Chapter 35: Tracheostomy + Laryngectomy

Question 1

What are the three parts of a Shiley classic trach used in a tracheostomy?

Answer 1

Trach
Introducer
Inner cannula with 15 mm connector

Question 2

Anatomy of a Shiley trach?

Answer 2

Body
Cuff
Inflation system
Swivel flange with tie downs

Question 3

Describe the flange of a Shiley trach?

Answer 3

Swivel flange with tie downs

Question 4

In what condition should a Shiley trach be if getting ready to insert?

Answer 4

Balloon should be deflated and stylet should be inserted.

Question 5

If the stylet is removed and the balloon is inflated, the Shiley trach is said to be in what position?

Answer 5

Operational; ready for PPV or suctioning

Question 6

A tracheostomy has two parts:

Answer 6

Trach body

Inner cannula

Question 7

Describe the body of a tracheostomy:

Answer 7

Cuff
Inflation system
Fixed flange with tie downs
15 mm connector

Question 8

Connector size for trachs?

Answer 8

15 mm

Question 9

Which type of trach has a swivel flange?

Answer 9

Shiley

Question 10

In what case would a patient require an XLT (extra length) tracheostomy tube?

Answer 10

If the patient has a lot of extra tissue in their neck area

Question 11

Perfusion wall pressure of tracheal mucosa?

Answer 11

25 cmH2O

Question 12

What are some intermediate and long term problems caused by tracheostomies?

Answer 12

Ischemia
Necrosis
Erosion
Dilation
Stenosis

Question 13

What gas can produce significant ischemic lateral-wall injury? How?

Answer 13

Nitrous oxide
If you inflate a balloon, eventually the gas that you use to inflate will seep out. In the case of air, it seeps out of the balloon and escapes, leaving a slight decrease in pressure. In the case of an O2/nitrous mix, it seeps out of the balloon and nitrous expands, rapidly + greatly increasing pressure.

Question 14

Which trach tube is a single-piece construction?

Answer 14

Kamen-Wilkinson trach

Question 15

Which trach tube features an adjustable flange?

Answer 15

Kamen-Wilkinson trach

Question 16

Describe the cuff of a Kamen-Wilkinson trach tube:

Answer 16

foam-filled cuff

Question 17

What are the distinguishing factors of a Kamen-Wilkinson trach compared to standard or Shiley?

Answer 17

Distinct inflation system

Foam filled cuff

Question 18

What is a Lanz-pressure regulating valve?

Answer 18

This valve will bounce back and forth as pressure in trachea from tracheostomy tube gets too high and will regulate pressure by emptying any excess air into a larger surrounding balloon.

Question 19

What are two critical considerations when placing a trach?

Answer 19

There should be no traction on the trach.

Maintain optimum cuff pressure.

Question 20

Which trach tube is all metal?

Answer 20

Jackson trach tube

Question 21

Why might a provider choose to use a Jackson trach tube over others?

Answer 21

Infection control

Question 22

Size of connector for pediatric trach?

Answer 22

15 mm connector

Question 23

In a Montgomery T-tube, orient the tube to the patient’s airway:

Answer 23

The longer section of the tube points leftward (downward) to the trachea. The offshoot points upward (leftward) to the connector. The shorter section of the the tube points rightward (upward) to the vocal cords.

Question 24

How do you connect a Montgomery t-tube to a circuit for positive pressure ventilation?

Answer 24

Via 15 mm connector

Question 25

What is a trach button?

Answer 25

A spacer that keeps trach open to maintain stomal patency for future access

Question 26

Is a trach button useful for PPV?

Answer 26

No, only used as a spacer

Question 27

What is a Kistner Trach?

Answer 27

It is a trach that maintains stomal patency for access to suction and permits speech.

Question 28

Which trach permits speech?

Answer 28

Kistner trach

Question 29

Is a Kistner trach useful for PPV?

Answer 29

No, only for suctioning and speech

Question 30

In what way does a talking trach allow speech?

Answer 30

It has a fenestration that allows cephalad gas flow and an inner cannula that is locked into the body; trach is cuffed.

Question 31

Describe the shape of a Communi-Trach?

Answer 31

The inner cannula/lumen is not circular; it is rounded on the bottom but then flat on top.

Question 32

Major gland that sits in front of the trachea?

Answer 32

Thyroid gland

Question 33

What kind of sutures do surgeons use in tracheostomies? Why?

Answer 33

Side-to-side stay sutures so that if the trach somehow slips or comes out, they can easy access the stoma again.

Question 34

How long after decannulation can you reinsert a trach?

Answer 34

About two weeks

Question 35

What is the purpose of a laryngectomy tube?

Answer 35

It is a placeholder; NOT useful in PPV

Question 36

What is the surgical result of a total laryngectomy?

Answer 36

Trachea is anastomosed to skin.

Question 37

If you wish to supply anesthesia and PPV to patients with trachs and laryngectomy tubes, how do you go about that?

Answer 37

Replace the trach with an anode ETT.

Question 38

What type of ETT allows you to supply anesthesia to a patient with a trach or laryngectomy tube?

Answer 38

Anode ETT

Question 39

If the surgeon is working on the upper region (skull, airway) of a patient with a trach/laryngectomy tube, what kind of anode ETT is best?

Answer 39

Caudad anode ETT

Question 40

If the surgeon is working on the thoracic region of a patient with a trach/laryngectomy tube, what kind of anode ETT is best?

Answer 40

Cephalad anode ETT

Question 41

Because we do not wish to put traction on a trach after surgery, what is our best option/preferred source for oxygen and humidity for our patient?

Answer 41

A trach collar