Intro to Trachs

39 Questions

What are 3 purposes of artificial airways?

Provides adequate ventilation and oxygenation Maintains an open airway Eliminates airway obstruction Reduces the potential for aspiration Facilitates the removal of secretions Provides access to the airway/lungs for pulmonary toilet

What is the difference between tracheotomy and techeostomy?

A tracheotomy is a surgical procedure and a tracheostomy is the tube used to maintain the tracheal opening after the surgical procedure.

Provide 3 examples of possible complications of tracheostomy placement

Infection (sepsis, pneumonia) Hemorrhage (skin vessels or major artery) Tracheal injury (inflammation, submucosal hemorrhage, ulceration, cartilage and mucosal necrosis) Tracheal perforation and tracheoesophageal fistula Tracheal web or pseudomembrane formation Irritation of the carina Self-decannulation Air leak Ineffective cough Pneumonia Mechanical problems with tube or cuff (obstruction, disconnection from ventilator) Patient discomfort

This is the name of the outside wall of the trach tube that provides the basic structure:

Outer cannula

This part of the trach tube creates a tight fit inside the outer wall and is available in a variety of sizes.

Inner cannula

What is the flange?

The "neck plate" that secures the tracheostomy tube in place around the patient's neck

This is the portion of the tube that is only used in the insertion process and is removed immediately afterwords.

Obturator

This is a small round piece of plastic placed in the tracheostomy tube to occlude the opening and used for patients learning to breath on their own

Button

This part of the trach tube is described as an internal ballon designed to keep air from escaping around the tube from the lower airway

Cuff

This type of trach tube has a singular or multiple holes on the body of the outer cannula to allow increased airflow through the vocal cords

Fenestrated

Which tube allows for the most upper airflow?

Fenestrated

Which tube allows for the least upper airflow?

Inflated Cuff

What are the 3 components of a cuffed trach tube?

Inflation line: pathway for air to inflate and deflate Pilot ballon: indicates how much air is in the ballon Syringe: adds or removes air through the valve of the pilot balloon

All trach tubes are disposable

False

The inability to communicate can cause frustration and fester anxiety, fear and panic in many patients. It can also compromise the appropriate medical treatment because patients are unable to effectively describe their condition or problems. What is the role of the SLP related to communication?

To provide the tracheostomized patients with the most effective and efficient means of communication is critical to the rehabilitation and well being of the patient.

A speaking valve allows your patient to breathe in through his or her trach tube. Describe this process.

After he/she inhales, the speaking valve closes. Air is breathed out (exhaled) up through the vocal cords, then through the mouth and nose. This allows them to phonate or speak.

What are 3 things we look at when determining candidacy for speaking valves?

Tolerance of cuff deflation (b/c air must flow through the larynx/pharynx) Proper size of the tracheostomy tube relative to the tracheal lumen Acceptable baseline of respiratory status

Speaking valves can be placed with a partially-deflated cuff

False

When patients are wearing speaking valves, pulse oximetry values should be above what percent to reduce risk of hypoxemia?

90%

What is the primary function of the lower respiratory tract?

To house the heart, blood vessels, nerves, and esophagus

What is the main purpose of an artificial airway?

To maintain an open airway and eliminate airway obstruction

What is the risk of not having an artificial airway in patients with respiratory failure?

Airway obstruction and respiratory failure

What is the material used to make disposable tracheostomy tubes?

All of the above

What is the purpose of the inner cannula in a tracheostomy tube?

To provide a tight fit inside the outer wall

What is a common complication of tracheostomy tube placement?

All of the above

What is the purpose of the cuff in a tracheostomy tube?

To keep air from escaping around the tube from the lower airway

What is the role of the SLP in patients with tracheostomy tubes?

To address communication disorders and improve patient outcomes

What is the difference between tracheostomy and tracheotomy?

Tracheotomy is the surgical procedure, while tracheostomy is the tube used

What is the purpose of the obturator in a tracheostomy tube?

To guide the tube through the tracheal opening during insertion

What is the main purpose of a speaking valve in a tracheostomy tube?

To allow air to flow from the trachea to the vocal folds

What type of tracheostomy tube is designed for single patient use?

Polyvinyl Chloride (PVC)

What is a contraindication for using a speaking valve?

Ventilator-dependent patients

What is the purpose of pulse oximetry in patients with a speaking valve?

To determine oxygen saturation of arterial hemoglobin

What is a non-disposable type of tracheostomy tube?

Silicone

What is the difference between a fenestrated and non-fenestrated tracheostomy tube?

Presence of holes on the outer cannula

Why is communication important for patients with a tracheostomy?

It helps to reduce anxiety and fear

What is a condition that may affect communication in patients with a tracheostomy?

Anarthria

What is the purpose of downsizing a tracheostomy tube?

To decrease breathing effort

What is the name of the device that attaches to the tracheostomy tube to allow patients to speak?

Passy-Muir speaking valve

Study Notes

Upper Respiratory Tract

The upper respiratory tract is the passageway for air to enter and leave the lungs, where air is warmed and humidified, and large impurities are filtered out before reaching the lungs.

Lower Respiratory Tract

The lower respiratory tract is housed in the thoracic cavity (thorax), formed by 12 thoracic vertebrae, sternum, and rib cage.

Diseases and Conditions Affecting the Respiratory System

Chronic obstructive pulmonary disease (COPD)
Chronic bronchitis
Emphysema
Pneumonia
Aspiration pneumonia
Pneumocystis carinii pneumonia (PCP)
Amyotrophic lateral sclerosis (ALS)
Multiple sclerosis (MS)
Muscular dystrophy
Guillain-Barré syndrome
Brainstem CVA
Poliomyelitis
Spinal cord injury
Congestive heart failure (CHF)
Adults respiratory distress syndrome (ARDS)

Purposes of an Artificial Airway

Provide adequate ventilation and oxygenation
Maintain an open airway
Eliminate airway obstruction
Reduce the potential for aspiration
Facilitate the removal of secretions
Provide access to the airway/lungs for pulmonary toilet

Tracheostomy

A surgical procedure that involves the placement of a plastic or metal tube into the airway by a physician
Performed when there is a need for an artificial airway

Tracheostomy Tubes

Made of polyvinyl chloride (PVC), silicone, or a mixture of plastics or metal
Disposable or non-disposable
Components: outer cannula, inner cannula, flange, obturator, button, cuff, and pilot balloon
Types: non-fenestrated and fenestrated

Tracheostomy Tube Components

Outer cannula: provides the basic structure
Inner cannula: creates a tight fit inside the outer wall and is available in various sizes
Flange: secures the tracheostomy tube in place around the patient's neck
Obturator: assists in guiding the tube through the tracheal opening
Button: occludes the opening and is also referred to as a "plug" or "cap"
Cuff: an internal balloon that keeps air from escaping around the tube

Tracheostomy Tube Sizes

Indicated on the flange
Inner and outer diameter measures are important

Purposes of Tracheostomy Tubes

Maintain an open airway
Eliminate airway obstruction
Reduce the potential for aspiration
Facilitate the removal of secretions
Provide access to the airway/lungs for pulmonary toilet

Infection (sepsis, pneumonia)
Hemorrhage (skin vessels or major artery)
Tracheal injury (inflammation, submucosal hemorrhage, ulceration, cartilage and mucosal necrosis)
Tracheal perforation and tracheoesophageal fistula
Tracheal web or pseudomembrane formation
Irritation of the carina
Self-decannulation
Air leak
Ineffective cough
Pneumonia
Mechanical problems with tube or cuff (obstruction, disconnection from ventilator)
Patient discomfort

Communication Goals for Tracheostomized Patients

Provide the most effective and efficient means of communication
Reduce frustration, anxiety, fear, and panic

Conditions Affecting Communication

Temporary conditions (short-term intubation)
Static conditions (physical condition not expected to change significantly)
Degenerative conditions (medical status expected to decline)

Speaking Valves

Allow tracheostomized patients to breathe in through their trach tube
Air is breathed out (exhaled) up through the vocal cords, then through the mouth and nose
Enable phonation or speaking
Example: Passy-Muir speaking valve

Candidacy for Speaking Valves

Tolerance of cuff deflation
Proper size of the tracheostomy tube relative to the tracheal lumen
Acceptable baseline of respiratory status

Contraindications for Speaking Valves

Ventilator-dependent patients
Inability to tolerate cuff deflation
Severe tracheal/laryngeal stenosis
Airway obstruction
Inability to tolerate full cuff deflation
End-stage pulmonary disease
Unstable pulmonary or medical status
Anarthria
Laryngectomy
Severe anxiety and/or severe cognitive impairment

1-19 = Jeopardy questions

Make Your Own Quizzes and Flashcards

Convert your notes into interactive study material.