Tracheostomies

Question 1

Tracheostomy

Answer 1

artifical airway
- temporary or permanent

Question 2

indications for traches

Answer 2

• head and neck cancers
• subglottic stenosis
• neuromuscular disease (MS)
• spinal cord injuries

Question 3

oral artificial airway

use

Answer 3

used to prevent tracheal obstruction caused by tongue displacement

Question 4

oral artificial airway

components

Answer 4

measure from corner of mouth to earlobe and put in arch side down then twist 180
- channel is inside the piece for suctioning

Question 5

Endotracheal airway

use

Answer 5

used to relieve and ventilate upper airway from an obstruction
- only for short term use
- “intubation” (GCS less than 8 time to intubate)

Question 6

Endotracheal airway female sizing

Answer 6

7-7.5mm

Question 7

Endotracheal airway sizing for men

Answer 7

8-9mm

Question 8

Tracheostomy

use

Answer 8

used long term and is completed through surgery

Question 9

tracheostomy sizing for women

Answer 9

10 mm

Question 10

tracheostomy sizing for men

Answer 10

11 mm

Question 11

indicastors for tracheostomy

4

Answer 11

• prolonged mechanical ventilation (day 10-14)
• upper airway obstruction
• upper airway surgeries (ENT)
• patient needs assistance monitoring long term

Question 12

Shiley tracheostomy tube

characteristics

Answer 12

• long term
• can be cuffed or uncuffed
• inner canula for cleaning
• can be fenestrated which allows for plugging
• non-fenestrated inner canula must be in before suctioning

Question 13

portex tracheostomy tube

characteristics

Answer 13

• short term (days to weeks)
• cuffed
• non fenestrated
• may have inner canula

Question 14

cuffed vs un-cuffed tracheostomy

Answer 14

whether or not there is a filled balloon seperating the upper and lower airway

Question 15

fenestration allows for…

Answer 15

patient to still breathe through airway

Question 16

parts of shiley trach tube

Answer 16

• shaft (main tube)
• inner canula
• pilot balloon (where you insert air to inflate cuff)

Question 17

obterator

Answer 17

used to insert trach

Question 18

Flange

Answer 18

sits outside of trachea on surface of neck to keep tube from falling in

Question 19

hypoxia resultung from tracheostomy

and interventions

Answer 19

occurs due to arterilal O2 lowering during suctioning
- prevent through hyperoxygenation prior to suctioning for at least 5 breaths

Question 20

tissue trauma resulting from tracheostomy

and interventions

Answer 20

occurs due to over suctioning (will see blood tinged sputum)
- intervention is only suction when needed, making sure to draw back when resistance is felt, deflate cuff as needed

Question 21

infection resulting from tracheostomy

and interventions

Answer 21

increased secretions, increased HR RR and temp, local infection around stoma; can be caused by cuff leaks
- follow asepsis to avoid, routine suctioning, provide oral care, ensure hydration and nutrition is adequate

Question 22

bronchospasm resulting from tracheostomy

and interventions

Answer 22

caused by stimulation of lungs (hit where it breaks off between right and left main stem)
- prepare to use ventolin or atrovent

Question 23

indications for suctioning

5

Answer 23

• secretions
• respiratory distress
• request
• aspiration
• need to obtain sample

Question 24

open system for suctioning

Answer 24

sterile catheter and glove

high risk for infection and must wear full PPE

Question 25

closed system for suctioning

Answer 25

In-line catheter | decreases chance of environmental contamination

Question 26

suctioning basics | pressure, how to do it, duration, time between, passes allowed

Answer 26

- sterile - pressure of 120-150 - pass until resistance is felt then pull back a bit - no longer than 10-15 sec - allow 5 breaths in between - only 2 passes

Question 27

aspiration | potential complicatiomn of suctioning

Answer 27

elevate HOB to 30-45, NPO, swallow assessment, monitor for abdominal distention

Question 28

assessment | sputum

Answer 28

trend changes and monitor for infection (amount, color, thickness) - auscultate lungs, check labs (WBC), temp, | unexpected is green, yellow, thick brown

Question 29

cuff leak | complication of trach/suctioning

Answer 29

can cause aspiration and inadequate seal can lead to infection - check if intact and inflated

Question 30

bleeding through and around stoma | complication of trach/suctioning

Answer 30

apply O2 and pressure, call physician, inspect stoma

Question 31

safety for bedside | before suctioning

Answer 31

bagger and mask, 10cc syringe, OPA, full O2 cylinder, sterile catheter and yankeur

Question 32

site care of trach | assessment timing and tie change timing

Answer 32

- care is done q12 hours (inner canula and dressing change) - tie changes done q24 hours (make sure you can fit 2 fingers or 4-5 cm) | clean around stoma, assess for skim breakdown

Question 33

psychosocial considerations

Answer 33

- yes and no questions - involve patient - explain who you are