Tracheostomies

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  • Created by: evepoag
  • Created on: 18-05-22 13:17
What are the 3 types of tracheostomy tubes?
Cuffed
Uncuffed
Fenestrated
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Describe a cuffed tracheostomy tube
When inflated, a balloon provides a seal in the trachea

Air does not pass through the upper airway, but through the tube

Used for ventilated patients or patients at risk of aspiration
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Describe an uncuffed tracheostomy tube
Does not have a balloon to inflate

Allows air to move through and around the trachea tube

Used in long-term patients who require suction to clear secretions - an effective cough is required
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Describe a fenestrated tracheostomy tube
It has holes in the outer cannula allowing air to pass through vocal cords in upper airway - patient can speak

Should not be given to patients at high risk of aspiration
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What factors influence the choice of trachea tube?
1. Respiratory function - eg: if on ventilator, will need a cuffed tube
2. Abnormal airway anatomy - eg: obese patients need longer tubes
3. compromised airway/weaning - eg: weaning patient from cuffed to fenestrated
4. wish to speak
5.obstructed airway
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What is a special function that can come with a trachea tube?
Supraglottic suction - allows us to aspirate secretions that build up that can cause pneumonia
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Why is an inner and outer cannula beneficial?
The inner cannula can be removed and changed without removing the entire outer cannula
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How do you change a trachea tube?
1. remove tube and clean stoma
2. use an absorbent dressing around the new tube to ensure it stays dry
3. re-insert the tube and replace tapes around neck to secure
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If cuff pressure drops too low, what can happen?
Aspiration of secretions, eventually pneumonia
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When should cuff pressure be checked?
Twice a day
After re-insertion
Suspected cuff leak
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How do you suction a trachea?
1. remove speaking valve or inner tube (if present)
2. insert appropriate catheter as far as recommended
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How do you close-suction a trachea and when is this used?
Used for ventilated patients or frequent suction is needed

1. ventilator stays in place during suctioning
2. there is a tube ready for suctioning
3. insert catheter into tube and remove afterward
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How do you clean the inner cannula of a trachea tube?
1. remove speaking valve
2. remove inner cannula
3. if disposable, throw away. if not, clean it
4. use sterile saline and clean outside with non-woven gauze
5. use foam-based cleaning swab to clean inside
6. re-insert cannula
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Why is humidification important?
Humidification usually happens in the nose and the trachea is preventing the use of the nose

If patients are on oxygen, this will dry them out

If patients are unwell, they can become dehydrated
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Describe the emergency tracheostomy management
1. look, listen, feel
2. if not breathing, call for help and apply high flow oxygen to both face and trachea
3. remove speaking cap and inner cannula
4. try to insert a suction catheter and deflate cuff (if present)
5. if catheter cannot be inserted...
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part 2
5. remove trachea
6. call resus team
7. start CPR, using bag-valve-mask on face, and covering the stoma
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When is verbal communication possible with a trachea?
With a speaking valve mask placed on an uncuffed or fenestrated tube
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What must you ensure you do before placing a speaking valve mask?
The cuff is deflated

Otherwise, you can cause airway occlusion
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What is the key difference between a tracheostomy and a larygngectomy?
In a trachea, there is two potential airways - through the upper airway, and through the trachea stoma

In a largyngectomy, there is one ONE airway - through the larynx stoma
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Other cards in this set

Card 2

Front

Describe a cuffed tracheostomy tube

Back

When inflated, a balloon provides a seal in the trachea

Air does not pass through the upper airway, but through the tube

Used for ventilated patients or patients at risk of aspiration

Card 3

Front

Describe an uncuffed tracheostomy tube

Back

Preview of the front of card 3

Card 4

Front

Describe a fenestrated tracheostomy tube

Back

Preview of the front of card 4

Card 5

Front

What factors influence the choice of trachea tube?

Back

Preview of the front of card 5
View more cards

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