Trachs Presentation Flashcards
(20 cards)
What is a tracheostomy and why is it used?
- Tracheotomy – surgical procedure
- ostomy means hole, created in the trachea
- Tracheostomy tube – placed to maintain the patency of the ostomy (required to keep the hole)
- Can be cuffed/uncuffed, different sizes
- Emergency airway – wean from endotracheal tube
- COPD – pulmonary toilet
- Upper airway obstruction – tumor, VF paralysis
- Diaphragmatic paralysis – ALS
- Attach to mechanical ventilator – trach to vent
- Can be permanent or temporary
What is a laryngectomy and why is this surgery
employed?
How does an individual with tracheostomy
communicate? Swallow?
How does an individual with laryngectomy
communicate? Swallow?
What is the role of the SLP working with these
patients?
Tracheostomy Overview
- Larynx in place
- Mouth communicates with lungs
- Requires tube to stent tract to airway
- Stoma will close after decannulation
- Can wear a speaking valve if appropriate to shunt air to upper airway and to vocal folds
- Aspiration risk due to reduced laryngeal movement, reduced sensation, etc.
Cuffed Trach
- Apply positive pressure
- Seals trachea to prevent leak from ventilation
Uncuffed Trach
- Limited positive pressure
- Allows communication of air and secretions to and from upper AD tract
Tracheostomized / Ventilator Dependent
- Trach involves placement of a tube below the level of the VFs to serve as an immediate airway.
- In general, the trach creates an open system (reduces normal pressures that would be generated for safe bolus flow)
- “anchors” the larynx to inhibit anterior/superior movement.
- Open system makes voicing difficult and coughing difficult to clear possible penetrants/aspirants.
- Ventilator is added when pt is unable to meet oxygen needs.
- Ventilator breathes for the pt.
- Cuffed tube
- Difficult to suspend breathing to swallow when an external device is breathing for the pt.
Passy Muir Valve
- Permits inhalation through tracheostomy and valve
- Prevents exhalation through trach
- Shunts air into upper AD tract through vocal cords
- Avoid use with cuffed tracheostomy tube
- Never use with inflated cuffed tube
- Best with small diameter tubes
- Candidacy assessment at the bedside/chairside
- Benefits swallowing
- If pt has cuff, make sure it is deflated due to choking risk.
Total Laryngectomy
- Removal of the entire larynx- sound source for communication – usually due to advanced laryngeal cancer
- Creates two separate tracts
- Breathing
- Swallowing
- Larynx removed
- Mouth only communicates with stomach
- Mouth->Stomach->Anus
- No connection of mouth and nose to trachea
and lungs - PERMANENT NECK BREATHER
- STOMA can NEVER CLOSE
- Cannot wear a speaking valve
- Initially patient may benefit from TUBE SUCH
AS TRACHEOTOMY OR LARYNGECTOMY TUBE
TO PREVENT STENOSIS - ZERO ASPIRATION RISK (***)
Changes in swallowing: TL
- Pts usually have some history of dysphagia and aspiration prior to TL
- Counsel re: disconnection between air tract and the swallowing tract
- Approx 50% of pt’s s/p TL will have some degree of dysphagia (Logemann, 2003)
- Pseudoepiglottis—pouch for retention
- Typically, 2/2 stricture, spasm
- Dysphagia is NOT circumvented, it just changes its phase
Methods of Speech Communication Post TL
Alaryngeal speech
1. Non-surgical
- Electrolarynx
- Esophageal speech
2. Surgical
- Tracheoesophageal puncture (TEP)
- Gold Standard
Electrolarynx
- Trutone, Solatone, Servox, Liberty
- Easy to learn—should begin training prior to surgery if possible
- Immediate communication
- Vibratory tissues, different sites
- Post op tissue edema can limit contact
- Edema can affect vibratory quality/output
- Battery-life issues
- Robotic quality of output
- “Pitch” control option
- Cost
- All pts with TL should have as “back up” if go TEP route
Tracheoesophageal Puncture
- According to Blom re-visiting idea for
TEP was butcher who had a TL and
knew anatomy from butchering” - Used a sterilized ice pick
- Punctured wall between the trachea and
esophagus - Kept open during communication (open
tract) - Placed quill in puncture to maintain
tract when not communicating
TE Prosthesis
- One way silicone flap valve in the puncture
- Valve was a conduit for air to flow from the trachea into the esophagus and vibrate the PE segment
- Valve closed on exhalation and to prevent aspiration
Flanges
- Two: Tracheal and Esophageal
- Valve is the central component
Types of TEPs
InHealth and Atos
Tracheostomy tube vs. LaryTube
Not created equal
- Different purpose
- Different angle
- TL patients should have a TL tube
not a tube for a person with an intact
larynx
web whispers website
created for patients with laryngectomy - support resource.
go to speaking again tab, you can look at different clips for examples.
