Flashcards in Emergency Surgical Procedure And Feeding Tubes Deck (30):
How do you treat an upper airway obstruction that is expected to reproved with appropriate treatment?
Brachycephalic airway disease
Mass (treatable)causing obstruction of upper airway
Oropharygneal or laryngeal trauma or foreign body
T/F: you should use the largest size that can be easily accommodated by the trachea for a tracheostomy
How is the patient positioned to place a tracheostomy tube?
Dorsal recumbency with neck placed over a rolled town
Clip and prep from mid mandible to manubrium
How is a tracheostomy tube placed?
Ventral midline incision 4-5cm to caudal edge of cricoid
Dissect between strap muscles — gelpi retractors aid in visualization
Transfer expense interannular incision (at 3-4 or 4-5 rings)
Place stay sutures around tracheal rings cranial and caudal to incision
Pull ET tube if resent
Remove obturator and replace with inner cannula
Can partially close incision if too long
Umbilical tape used to secure tube around neck
What nursing care is required for tracheostomy tubes?
Removed inner cannula and replace with new one :
Nebulize 20 mins
Pre-oxygenate for 3-5mins
Suction trachea with sterile suction tip to level or carina
Oxygen for 3-5mins
Replace cleaned inner cannula
Clean skin around tracheostomy incision
Replace tube every 24hours
Complications that can caries from tracheostomy?
Tube occlusion — respiratory distress and death (mucous plug, dried secretions within tube)
Airway suctioning — hypoxemia, atelectasis, vagally mediated bradycardia and collapse
Surgical site infection
Coughing, gagging, vomiting
How do you remove a tracheostomy tube?
- temporarily remove tube
-place a smaller tube
Allow site to heal by second intention
Suturing site can result in SQ emphysema that can progress to pneumomediastum or pneumothorax
Purpose or thoracocentesis?
Therapeutic or diagnostic
- can be performed with local block and sedation
- useful in patients in distress due to pleural effusion or pneumothorax — PRIOR to chest rads and thoracotomy tube placements
Generally, what location do you do thoracocentesis?
6th, 7th, 8th intercostal space, near costochondral junction or pleural effusion, mor dorsal with pneumothorax
What are thoractostomy tubes used for?
Placed aspectically under generalized anesthesia
How do you pick tube size for thoracostomy tubes?
Based on need for evacuation
- larger tube for supperative effusion
- smaller tube for air
Width of tube should be
how long should a thoracostomy tube be?
Should start dorsal 1/3rd of thoracic wall at 7-9th intercostal space and end at the point of the elbow
How do you place a thoracostomy tube?
Incision at dorsal 1/3rd of ICS 10-12 (2-3 rib spaces caudal to desired intercostal entry point
Secure tube with Kelly hemostat and advance tube sQ and cranially
At ICS 7-9, reposition tube perpendicular to thorax and apply pressure to hemostat and tube through intercostal muscles
Advance catheter with trochar/hemostat prior to feeing catheter, then advance to ICS 2-3rd as trochar is removed
Cap or clamp tube
Secure with purse string and finger trap suture pattern (non absorbable nylon)
T/F: if position of a thoracostomy tube needs to be change, you can back out the tube but not insert if further into thorax
What is used to ensure a close thoracotomy tube system?
Christmas tree adapter
When should your thoracostomy tube be removed?
When air or fluid production is decreased
Air: absence of penumothorax for 12-24hrs
Fluid: production of less than 2mls/kg/day
- sutures are removed and the tube pulled out quickly
-site covered with bandage
What type of feeding tubes can you place>
What types of catheters can be used for gastrotomy tubes?
D Pezzer (mushroom tip) cathete
Where are enterostomy tubes placed?
Through pyloris into distal duodenum/proximal jejunum
How is a gastrotomy tube sutured in place?
Purse-string around tube
Gastropexy also done to secure stomach to body wall
The initial suture of the purse string for a gastrotomy tube should engage what layers?
Fascia and skin
How long MUST a gastrotomy tube be placed for
In what patients would you consider an enterostomy tube?
Desired to “rest” upper GI tract
A 10 g needle can fit at _____Fr catheter
A 12g needle can fit at _____F catheter
A 14 or 16g catheter can fit a _______Fr catheter
How is an enterotomy tube placed?
Needed inserted through intestinal wall obliquely
Purse string placed around hold
Insert tube through sutured hold
Advance tube abnormally 8-12inches
Secure tube with purse string
Enteropexy — pexy tube to body wall with 4 quadrant sutures/interlocking box
How is an enterostomy tube secured externally?
Should engage fascia of body wall to minimize siding of tube
How are gastro/entersostomy tubes maintained?
Flush with saline intraop
Start feeding when recovered from anesthetics
Remove when no longer needed