Trach Care

Question 1

How should one measure for sizing an oropharyngeal airway?

Answer 1

Measure (quick if an emergency) – base it also on age and size of person. Put flange parallel to teeth and the curved part next to the cheek – tip should be at the angle of the jaw.

Question 2

What size of oropharyngeal airway do babies and small children use?

Answer 2

000 to 3

Question 3

What size of oropharyngeal airway do bigger children normally wear?

Answer 3

3 to 4

Question 4

What size of oropharyngeal airway do adults usually wear?

Answer 4

4 and over

Question 5

Who should not have a nasopharyngeal airway inserted?

Answer 5

Patients with facial trauma.

Question 6

What is the purpose of oral airway suctioning?

Answer 6

Removes secretions from the mouth (will also remove O2)

Question 7

What is oropharyngeal suctioning?

Answer 7

Inserted through the mouth to the pharynx

Question 8

What is nasopharyngeal suctioning?

Answer 8

Inserted via nares to pharynx.

Question 9

What are some complications of airway suctioning?

Answer 9

Complications – (negative aspects)
disruptive to mucous membranes
Damage mucous membranes
Uncomfortable
Bradycardia
Hypoxic patients can become tachycardic
Increased potential for infection
Laryngeal spasm

Question 10

What are some anatomical features of the trachea?

Answer 10

The trachea is the first part of the airway not shared by GI tract
Trachea stretches between the larynx and the carina
In the average adult it is 10-12cm long and 2.5cm in diameter
The trachea is protected by 16-20 hyaline cartilage rings which help to maintain patency

Question 11

How is the placement of a tracheostomy checked?

Answer 11

X-ray

Question 12

Are tracheostomies temporary or permanent?

Answer 12

Can be temporary or permanent.

Question 13

What is the purpose of a tracheostomy tube?

Answer 13

The tube keeps the stoma open. It shortens the length of the upper airway, and decreases the work of breathing for the patient.

Question 14

What is a tracheostomy?

Answer 14

An artificial opening (or stoma) in the trachea

Question 15

Where is a tracheostomy created?

Answer 15

Surgically created between 2nd and 3rd cartilaginous ring

Question 16

What are some indications for tracheostomy?

Answer 16

Upper airway obstruction
Upper airway bleeding
Trauma/burns
Prolonged artificial ventilation
Respiratory insufficiency
Inability to clear secretions effectively
Inability to protect own airway

Question 17

What are some complications of tracheostomy?

Answer 17

Airway occlusion
Tissue damage (necrosis, ulceration)
Infection
Communication difficulties
Tube displacement/dislodgement
Bleeding
Tracheo-oesophageal fistula
Inability to maintain nutrition/hydration needs
Air leaks
Loss of normal airway function
Decreased sense of smell/taste
Decreased nutritional intake (as a result of decreased smell/taste)

Question 18

What are tracheostomy tubes made of?

Answer 18

Silicone.

Question 19

What are some variations in the designs of tracheostomy tubes?

Answer 19

Vary in length, size, composition and number of parts. Can also be cuffed or uncuffed, fenestrated or non fenestrated.

Question 20

What is the purpose of a fenestrated tracheostomy tube?

Answer 20

Fenestrated = has holes in it. Fenestrated ones allow air to go up and out of the airway, as well as breathe through the trach tube. This can help them to have a little bit of a voice.

Question 21

What is the purpose of a cuffed tracheostomy tube?

Answer 21

Cuff is to occlude the airway to reduce the risk of aspiration.

Question 22

What kind of patients would require a cuffed tracheostomy tube?

Answer 22

Patients on a ventilator.

Question 23

What are the three components of a tracheostomy tube?

Answer 23

Outer cannula (cuffed/uncuffed)
Inner cannula
Obturator

Question 24

What is an attachment for tracheostomy tubes that are optional?

Answer 24

May have speaking valves attached (these are expensive, $300-$400)

Question 25

What are some nursing implications for caring for patients with a trach tube?

Answer 25

``` Preparation Patient assessment Patient education Communication/body image Procedures Emergencies Guidelines and documentation ```

Question 26

What should the nurse do to prepare for trach care?

Answer 26

``` Equipment at bedside Patient assessment Procedures discussed with patient Patient in correct position 2nd nurse identified to help (if necessary) with procedures ```

Question 27

What are some important aspects of patient assessment when performing trach care?

Answer 27

``` Why does the patient have a tracheostomy? How long have they had a tracheostomy? Type/size of tube Level of respiratory support needed Respirations/breath sounds Cuffed?/inflated? Humidification method? Suction required?/how often? Thickness, colour, amount of sputum Cleaning of inner tube? Wound assessment/dressing changes Can the patient swallow? Assessment done? Weaning progress When does the outer tube need changing? What does the patient look like? Patient education Mouth care ```

Question 28

What are some important aspects f patient education for patients with tracheostomy?

Answer 28

``` Explain all procedures Pre-op education Communication limitations/alternatives Involve family Utilize other experts as appropriate ```

Question 29

What is the reason that humidification is required for a patient with a tracheostomy tube?

Answer 29

Humidification occurs in the upper airway. When a tracheostomy is formed, the upper airway is bypassed. Humidification warms and moistens the air.

Question 30

What are some possible complications of humidification for a trach patient?

Answer 30

Potential for fluid build-up in corrugated tubing | Insufficient/excessive humidification

Question 31

How often should the inner cannula of a tracheostomy be changed?

Answer 31

Once per shift and PRN

Question 32

What are some dressing and cannula change basic principles?

Answer 32

``` Preparation Asceptic/clean technique Patient education Wound assessment Documentation ```

Question 33

Is a tracheosomy inner cannula change a clean procedure or a sterile procedure?

Answer 33

Clean

Question 34

What procedures regarding trach care need to be sterile?

Answer 34

Caring for a new tracheostomy (first 5-7 days) | Suctioning a tracheostomy

Question 35

What are some indications for suctioning tracheostomy?

Answer 35

``` Visible or audible secretions Suspected aspiration Dropping peripheral O2 sats Increased coughing Reduced airflow ```

Question 36

What are some adverse affects of suctioning?

Answer 36

Hypoxia Trauma Infection As necessary

Question 37

What are some measures the nurse can take in order to prevent hypoxia when suctioning a tracheostomy?

Answer 37

Might need to pre-oxygenate them a little bit. If they aren’t on continuous oxygen, we can get them to take some big deep breaths to get a bit more oxygen into them before they are suctioned. When we suction, three passes and then done. If you can’t get the secretions out with 3 passes, you need to wait a bit before trying it again. Should only have the suction in there for 10-15 seconds at a time.

Question 38

What are some measures the nurse can take in order to prevent trauma when suctioning a tracheostomy?

Answer 38

- Apply suction on the way out, not the way in. As you introduce the suction catheter into the tube, they will start coughing. When they cough, pull it out a bit and then start the suction. If you suction on the way in, you can accidentally suction the mucous membranes and cause trauma to the tissues.

Question 39

What emergency equipment should you have available for a patient with a tracheostomy?

Answer 39

Suction machine (on the wall) Suction catheters If they have inline suction, make sure they have a spare one of those If not in-line suction, make sure they have 2 or 3 extra We need a whole tracheostomy unit that is the same size as the one the patient is wearing, as well as one that is one size smaller. The oxygen on the wall should be working. Make sure you have 2 or 3 spare inner cannulas. We should have a dilator (these are foreceps that if you squeeze it, it opens). If it is a relatively new tracheostomy and the tube falls out, these will be necessary to keep it open. If it is well-established, we shouldn’t need these. But they are necessary to have in case of emergency. Velcro 10mL syringe (to deflate the cuff in an emergency). If we don’t have one, make sure you have scissors and you can just cut it and the cuff will deflate. Mask Eye proception Gloves Bag