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dysphagia final > Trach tubes > Flashcards

Trach tubes Flashcards

(43 cards)

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1
Q

Why would someone need a trachea tube?

A
  1. upper airway obstruction at or above the level of the vf’s
  2. potential for airway obstruction (post surgery edema)
  3. provision of respiratory care
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2
Q

how is the trach tube inserted?

A

it is inserted by a surgeon between the 3rd and 4th tracheal ring.

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3
Q

what are the 3 parts of a trach tube?

A 
outer cannula (holds the trach site open)
inner cannula (actual tube for breathing)
obturator (smooth tip for initial insertion)
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4
Q

What are the 3 types of trach tubes?

A

cuffed
cuffless
fenestrated

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5
Q

what trach tube is used for long term use?

A

cuffless

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6
Q

which trach tube is used with a ventilator?

A

cuffed

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7
Q

which trach tube is for weaning and decannulation?

A

fenestrated

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8
Q

which tube prevents aspiration?

A

cuffed

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9
Q

what is the cuffed part of the cuffed trach tube used for?

A

it is inflated for positive pressure

it is inflated against the tracheal walls and prevents aspiration

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10
Q

Can aspiration occur with the cuff less trach tube?

A

yes

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11
Q

can the cuff less trach tube interfere with laryngeal excursion?

A

yes

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12
Q

what trach tube assists breathing and secretion removal?

A

cuffless

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13
Q

which trach tube is short term (3-5 days)?

A

fenestrated (its smaller than the other tubes)

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14
Q

What are the 11 steps for swallowing treatment for people with a trach?

A
  1. know ptnt hx
  2. Know the kind of trach tube
  3. Know how long the trach tube has been in (longer than 6 mos may cause scarring which can restrict laryngeal elevation)
  4. Deflate cuffed tube (w/ medical clearance)
  5. Suction oral and trach as it is deflated (prevents aspiration)
  6. ptnt occludes airway with gloved hand/gauze/one-way speech valve during and several seconds after swallow to create near-normal pressure and clear possible airway residues
  7. dry swallow first
  8. write down instructions for swallow
  9. no more than 3 cc of the substance for swallow trials 5-finger test & be ready to suction!
  10. cough cough!
  11. phonate sustained vowel after swallow, head turn
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15
Q

Does the persons swallow usually worsen on vent? If yes why?

A

yes
respiration is controlled by the vent
ptnt can’t lengthen exhalation for swallow (disrupted swallow)

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16
Q

What kind of trach tube goes with a ventilator?

A

cuffed

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17
Q

What are the three things for swallowing treatment for people on a ventilator?

A

timing of swallow at exhalation
blue dye test
present a variety of consistencies

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18
Q

explain the blue dye test…

Study These Flashcards
A

dye the consistency blue use a lot more dye to test for aspiration have them drink or eat it see if any blue coming out of trachea tube—test for aspiration (if blue dye comes out they are aspirating)

19
Q

What are some side effects/complications that can happen when you are intubated?

Study These Flashcards
A

-laryngeal trauma from tube placement
-TE fistula from tube rubbing
-laryngeal pathologies: granuloma, vf paresis/paralysis, edema, erythema
-

20
Q

what are the swallowing treatment for someone who is intubated?

Study These Flashcards
A

there is none!!! none until extubated for at least a week

then after that can do ROM exercises

21
Q

What are the three types of naso tubes?

Study These Flashcards
A

NG-nasogastric
ND-nasoduodenal
NJ-Nasojenal

22
Q

Explain an NG tube?

Study These Flashcards
A

tube is placed nasally

23
Q

What is OG tube?

24
Q

What are the three kinds of gastro tubes?

Study These Flashcards
A

G or GT: gastrostomy
GD: gastrostomy into the jejunum
J/GJ/PEJ: jejunostomy

25
Explain PEG tubes?
PEG tube is not the actual tube it is the method in the way the tube is inserted it is placed by percutaneous endoscopic/laparoscopic gastrostomy (the tubes are G or GT/GD/GJ tubes)
26
What is the RIG method for feeding tubes?
Method where the tube is radiologically instead (x-ray) gastrostomy
27
What is the surgical method of inserting a feeding tube?
method open or laparascopically instead gastrostomy
28
What are the red flags for needing a feeding tubes?
weight loss | hydration
29
what percent of weight loss is common (moderate)?
10%-20% less is common
30
what is considered severe weight loss?
>20% weight loss is severe
31
what are the signs of hydration (Scheprd)
``` skin turgor complaints of thirst hypernatremia (increased sodium) elevated bun (blood urea nitrogen) patients with thin liquid dysphagia rapid weight loss 4+ lbs in 48 hrs decreased urination ```
32
what are the advantages of a Nasogastric tube (NG)
- minimally invasive - easy placement - suitable for short term use - transitional to bolus (oral) feeding - radiographic confirmation not necessarily required if clinically confirmed placement in stomach
33
what are the disadvantages of a nasogastric tube (NG)?
- cosmetic -feeding tube is visible - risk of sinusitis - lack of intact gag reflex may indicate increase aspiration risk (not for all cases) - stomach must be uninvolved with the primary disease
34
what are the advantages of the ND tube nasoduodenal?
- minimally invasive - suitbale for short term use - reduced risk of aspiration - useful in conditions of repaired stomach emptying aka gastroparesis - useful if esophageal reflux present - allows for feeding when bowel sounds are diminished or absent???
35
What are the disadvantages of the ND (nasoduodenal) tube?
- requires radiographic confirmation for placement - cosmetic-feeding tube is visible - risk of sinusitis - bolus feeding is not an option (bc of stomach issues/gastroparesis) - feeding pump is needed, reducing the mobility of patient when feeding - 43 inch length feeding tube is preferred - may not remain placed in duodenum bc of tube migration (tube can migrate) - typically smaller diameter tube than NG more prone to plugging if not properly maintained
36
What are the advantages of the NJ (nasojejunal tube)?
- minimally invasive - suitable for short term - decreases risk of aspiration - useful for conditions of impaired stomach emptying (gastroparesis) - useful if esophageal reflux is present - allows for feeding when bowel sounds are diminished or absent two others not the same as ND: - placement of tip further down gi tract minimizes dislocation of tube into stomach - 60 inch length tubes available offering even greater placement security
37
what are the disadvantages of NJ (nasojejunal tube)?
similar to the advantages of the ND except the placement of the tip is more secure - requires radiographic confirmation for placement - cosmetic-feeding tube is visible - risk of sinusitis - bolus feeding is not an option (bc of stomach issues/gastroparesis) - feeding pump is needed, reducing the mobility of patient when feeding - may not remain placed in duodenum bc of tube migration (tube can migrate) - typically smaller diameter tube than NG more prone to plugging if not properly maintained
38
What are the advantages of the Gastrostomy tube?
- suitable for long term feeding - cosmetically more appealing than nasally placed tubes - minimizes risk of tube migration and aspiration bc of voluntarily or accidental dislocation of nasoenteric tube by ptnt - percutaneous placement available (PEG) - Some GT have large bore tubes which minimize occlusion from medications and high viscosity formulas - most suitable of all tubes for use of homemade formula provided that the tip is placed in the stomach and the tube is large
39
what are the disadvantages of the Gastrostomy tube?
- potential risk of aspiration - lack of intact gag reflex and/or presence of esophageal reflux may indicate increased risk of aspiration - insertion site care needed - potential skin excoriation at stoma site from leaking of gastric secretions - potential fistula at insertion site after GT removal - if GT feeding tip port is placed in duodenum usually a smaller bore tube is used and subject to more occlusion risk
40
What are the advantages of a gastrojejunostomy?
similar advantages as the gastrostomy | -dual lumen tube allows access to the stomach , duodenum or jejunum, depending on length of enteric portion of the tube
41
what are the disadvantages of a gastojejunostomy?
-similar to the gastrostomy tube duodenal/jejunal portion of tube may dislodge from initial placement position -the jejunal tube lumen usually is of a small bore (diameter) and is subject to more occlusion risk
42
What are the advantages of a jejunostomy?
- suitable for long term feeding - minimizes risk for aspiration - pos gag reflex need not be present - useful if esophageal reflux is present - does not depend on functioning stomach
43
what are the disadvantages of a jejunostomy?
- typically a smaller bore tube than a GT and at risk for occlusion from medication or viscus formula if not properly maintained - stoma care needed - bolus feeding is not an option - feeding pump is needed, reducing the mobility of the ptnt when feeding - potential fistula at stoma sight after JT removal

dysphagia final (2 decks)

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