Intro to Trachs
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Questions and Answers

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. (correct)
  • A tracheostomy is a surgical procedure and a tracheotomy is the tube used to maintain the tracheal opening after the surgical procedure.
  • Both involve surgery
  • Neither involve surgery

    • 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:

    <p>Outer cannula</p> Signup and view all the answers

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

    <p>Inner cannula</p> Signup and view all the answers

    What is the flange?

    <p>The &quot;neck plate&quot; that secures the tracheostomy tube in place around the patient's neck</p> Signup and view all the answers

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

    <p>Obturator</p> Signup and view all the answers

    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

    <p>Button</p> Signup and view all the answers

    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

    <p>Cuff</p> Signup and view all the answers

    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

    <p>Fenestrated</p> Signup and view all the answers

    Which tube allows for the most upper airflow?

    <p>Fenestrated</p> Signup and view all the answers

    Which tube allows for the least upper airflow?

    <p>Inflated Cuff</p> Signup and view all the answers

    What are the 3 components of a cuffed trach tube?

    <p>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</p> Signup and view all the answers

    All trach tubes are disposable

    <p>False</p> Signup and view all the answers

    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?

    <p>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.</p> Signup and view all the answers

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

    <p>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.</p> Signup and view all the answers

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

    <p>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</p> Signup and view all the answers

    Speaking valves can be placed with a partially-deflated cuff

    <p>False</p> Signup and view all the answers

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

    <p>90%</p> Signup and view all the answers

    What is the primary function of the lower respiratory tract?

    <p>To house the heart, blood vessels, nerves, and esophagus</p> Signup and view all the answers

    What is the main purpose of an artificial airway?

    <p>To maintain an open airway and eliminate airway obstruction</p> Signup and view all the answers

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

    <p>Airway obstruction and respiratory failure</p> Signup and view all the answers

    What is the material used to make disposable tracheostomy tubes?

    <p>All of the above</p> Signup and view all the answers

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

    <p>To provide a tight fit inside the outer wall</p> Signup and view all the answers

    What is a common complication of tracheostomy tube placement?

    <p>All of the above</p> Signup and view all the answers

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

    <p>To keep air from escaping around the tube from the lower airway</p> Signup and view all the answers

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

    <p>To address communication disorders and improve patient outcomes</p> Signup and view all the answers

    What is the difference between tracheostomy and tracheotomy?

    <p>Tracheotomy is the surgical procedure, while tracheostomy is the tube used</p> Signup and view all the answers

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

    <p>To guide the tube through the tracheal opening during insertion</p> Signup and view all the answers

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

    <p>To allow air to flow from the trachea to the vocal folds</p> Signup and view all the answers

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

    <p>Polyvinyl Chloride (PVC)</p> Signup and view all the answers

    What is a contraindication for using a speaking valve?

    <p>Ventilator-dependent patients</p> Signup and view all the answers

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

    <p>To determine oxygen saturation of arterial hemoglobin</p> Signup and view all the answers

    What is a non-disposable type of tracheostomy tube?

    <p>Silicone</p> Signup and view all the answers

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

    <p>Presence of holes on the outer cannula</p> Signup and view all the answers

    Why is communication important for patients with a tracheostomy?

    <p>It helps to reduce anxiety and fear</p> Signup and view all the answers

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

    <p>Anarthria</p> Signup and view all the answers

    What is the purpose of downsizing a tracheostomy tube?

    <p>To decrease breathing effort</p> Signup and view all the answers

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

    <p>Passy-Muir speaking valve</p> Signup and view all the answers

    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

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