2-3 Airway Managment - 21 September University For Medical Sciences PDF

‫ سبتمبــــــــر للـــعــــلوم الطـــــبية‬21 ‫جـــــامعــة‬ 21 September University For Medical Sciences Equipment of respiratory Care Airway Management 2ed year respiratory therapist student Dr:MOHAMMED-SENAN BS, RCP, MsRC Purpose of this Discussion...

‫ سبتمبــــــــر للـــعــــلوم الطـــــبية‬21 ‫جـــــامعــة‬ 21 September University For Medical Sciences Equipment of respiratory Care Airway Management 2ed year respiratory therapist student Dr:MOHAMMED-SENAN BS, RCP, MsRC Purpose of this Discussion 1. Understand the Equipment used to assist in control airway. 2. Know more about OPA,NPA ,LMA, Tracheostomy and Endotracheal tubes. 3. Know more about specialized endotracheal tubes. 4. Understand the Equipment used to assist intubation Introduction Respiratory Care…a Life and Breath Career for You! You can live without food for a week, without water for a day, but you cannot live without air for more than a few minutes. JUn224 DrMohammmed Senana 3 Introduction Who is Respiratory Therapists? Respiratory therapists is the health profession that specializes in the promotion of optimum cardiopulmonary function and health. Respiratory therapists apply scientific principles to prevent, identify, and treat acute or chronic dysfunction of the cardiopulmonary system. JUn224 DrMohammmed Senana 4 Introduction Artificial Airways Artificial airways are specialized medical devices that are designed to maintain a patent, or open, airway. Depending on the device, it may only displace the tongue or it may be inserted directly into the trachea. Artificial airways work by bypassing areas of obstruction or preventing vomitus or foreign material from obstructing the airway. Airways may be placed to prevent or to relieve airway obstruction. JUn224 Dec-24 DrMohammmed Senana 5 Content of Airway Management:- 6  Any device that aims to maintain oral or nasal air passage  It can be subglottic or supraglottic O.P.A N.P.A L.M.A ETT Tracheostomy  1 OroO.P.ATube O.P.A JUn224 DrMohammmed Senana 7 1-Oropharyngeal Airway insertion Oro pharyngeal airway (OPA) : also called oral airways, It's rigid tube inserted through mouth to pharynx. It used in an unconscious patient to reduce risk of obstructing the airway with the tongue, prevent potential laceration of the tongue or lips if the patient has a seizure (convulsion) and relance the airway. JUn224 DrMohammmed Senana 8 1-Oropharyngeal Airway insertion Indication of Oropharyngeal Airway: Unresponsive patients without cough or gag reflex (Oropharyngeal airway placement requires absent cough or gag reflex). Unconscious patient with difficult bag/mask seal patient with seizure (convulsion). Patient with ETT to prevent kinking of the softer endotracheal tube by teeth(bite block). Suctioning a patient with ETT and severe secretion from mouth. Contraindications of Oropharyngeal Airway: Conscious patients Any patient has gag reflex JUn224 DrMohammmed Senana 9 1-Oropharyngeal Airway insertion Complications of Oropharyngeal Airway Gagging/vomiting, aspiration laryngospasm in the alert or semiconscious patient (in patients with gag reflex), so taking into account suction machine with suction tubes. Damage to teeth and oral mucosa, and bleeding Airway obstruction or Failure of airflow ❖ If Oropharyngeal airway too long can push pressure on the epiglottis and may obstruct airway during insertion. ❖ If Oropharyngeal airway too short can push the tongue to back (against the posterior pharyngeal wall ) during insertion JUn224 DrMohammmed Senana 10  2 N.P.A NasN.P.Aeal JUn224 DrMohammmed Senana 11 2-Nasopharyngeal Airway insertion Nasopharyngeal airway (NPA) : also called nasal airways or “trumpets”, It's “soft rubber or silicone inserted through nose to pharynx. It cane used in an conscious patient ,to upper airway obstruction caused by the tongue or soft palate falling against the posterior wall of the pharynx and as diluter to the nose. JUn224 DrMohammmed Senana 12 2-Nasopharyngeal Airway insertion Indication of Nasopharyngeal airway: Patients who will not tolerate an oropharyngeal airway. Patients without History of fractured nasal bone. Facilitation of spontaneous breathing and bag-valve-mask ventilation in patients requiring head-tilt/chin-lift or jaw-thrust maneuvers. It may be possible to avoid intubation with frequent suctioning through a nasal airway in some patients. Contraindications of Oropharyngeal Airway: patient with nasal bleeding or bleeding disturbance. patient with or suspected basilar skull fractures (CSF discharge from nose). patient with nasal trauma (facial trauma). resistance of insertion(patient with nasal polyp) JUn224 DrMohammmed Senana 13 2-Nasopharyngeal Airway insertion Complications of Nasopharyngeal Airway: Epistaxis Deterioration requiring intubation (semiconscious patient) Semiconscious patients with nasopharyngeal airways may deteriorate and require intubation, so they should be monitored closely. JUn224 DrMohammmed Senana 14  3 LaL.M.ArAirway L.M.A JUn224 DrMohammmed Senana 15 3-laryngeal Mask Airway JUn224 DrMohammmed Senana 16 3-laryngeal Mask Airway JUn224 DrMohammmed Senana 17 3-laryngeal Mask Airway JUn224 DrMohammmed Senana 18 3-laryngeal Mask Airway JUn224 DrMohammmed Senana 19 3-laryngeal Mask Airway JUn224 DrMohammmed Senana 20 3-laryngeal Mask Airway JUn224 DrMohammmed Senana 21  ADVANCED AIRWAY MANAGMENAT 4 EE.T.Tn E.T.T JUn224 DrMohammmed Senana 22 4-Endotreacheal tube ENDOTRACHEAL TUBES are hollow pliable airways usually made from polyvinyl chloride (PVc). The airway is inserted through the mouth or nose, through the larynx, and into the trachea. In proper position, the distal tip of the tube should be approximately 2 centimeters above the carina. correct placement can be verified by examining the airway on a chest radiograph. The endotracheal tube is hollow, allowing gas to flow through the airway. This type of airway may be used to bypass soft tissue obstructions. The component parts of an endotracheal tube include the cuff, pilot tube and pilot balloon, and Murphy eye. JUn224 DrMohammmed Senana 23 4-Endotreacheal tube Indication for intubation: - Maintain airway patency - Prevent from aspiration - Cardiopulmonary arrest - Establishment or maintenance of mechanical ventilation - Bronchial hygiene Contraindications for Intubation: - Patients with an intact gag reflex. - Patients likely to react with laryngospasm to an intubation attempt. e.g. Children with epiglottitis. - Basilar skull fracture – avoid nose-tracheal intubation and nasogastric /pharyngeal tube. JUn224 DrMohammmed Senana 24 4-Endotreacheal tube Advantages of Endotracheal intubation - Cuffed E.T tubes protect the airway from aspiration. - E.T tube provides access to the tracheobronchial tree for suctioning of secretions. - E.T tube does not cause gastric distention and associated danger of regurgitation. - E.T tube maintains a patent airway and assists in avoiding further obstruction. - E.T tube enables delivery of aerosolized medication. JUn224 DrMohammmed Senana 25 4-Endotreacheal tube Complications associated with Intubation - Nasotracheal tubes can damage the turbinate's,cause epistaxis, and even perforate the nasopharyngeal mucosa. - Hypertension and tachycardia can occur from the intense stimulation of intubation; This is potentially dangerous in the CAD patient with coronary heart disease. - Transient cardiac arrhythmias related to vagal stimulation or sympathetic nerve traffic may occur - Damage to the endotracheal tube cuff, resulting in a cuff leak and poor seal. JUn224 DrMohammmed Senana 26 4-Endotreacheal tube Complications associated with Intubation - Intubation of the esophagus, resulting in gastric distention and regurgitation upon attempting ventilation. - Baro-trauma resulting from over ventilating with a bag without a pressure release valve(pneumothorax). - Over stimulation of the larynx resulting in laryngospasm, causing a complete airway obstruction. - Inserting the tube to deep resulting in unilateral intubation (right bronchus). - Tube obstruction due to foreign material, dried respiratory secretion and/or blood. JUn224 DrMohammmed Senana 27 4-Endotreacheal tube Identification of ET Tube: JUn224 DrMohammmed Senana 28 5-Endotreacheal tube JUn224 DrMohammmed Senana 29 4-Endotreacheal tube JUn224 DrMohammmed Senana 30 4-Endotreacheal tube General Guide to Choice of Endotracheal Tube Note : the ET tube size 5 or greater will have a cuff, whereas tubes smaller than 5 are typically cuffless JUn224 DrMohammmed Senana 31 4-Endotreacheal tube JUn224 DrMohammmed Senana 32 4-Endotreacheal tube JUn224 DrMohammmed Senana 33 4-Endotreacheal tube JUn224 DrMohammmed Senana 34 4-Endotreacheal tube JUn224 DrMohammmed Senana 35  Equipment for intubation 4-Endotreacheal tube remember Prepare (ELSAMO) :- JUn224 DrMohammmed Senana 36 EQUIPMENT USED TO ASSIST IN INTUBATION Besides the laryngoscope and the laryngoscope blades, other equipment will facilitate intubation and minimize potential complications. suction equipment, forceps, stylets, and end-tidal cO2 detection devices are important to facilitate intubation. EQUIPMENT USED TO ASSIST IN INTUBATION Magill Forceps are long, curved forceps that facilitate endotracheal tube placement by allowing the practitioner who is intubating to grasp the endotracheal tube to better guide its advancement into the airway (Figure 5-32). Magill forceps are frequently used when nasally intubating a patient, guiding the tip of the tube into the trachea. Magill forceps may also be used to remove foreign material from the airway, allowing the practitioner to grasp the object and remove it EQUIPMENT USED TO ASSIST IN INTUBATION.The stylet (Figure 5-33) is a semirigid protected wire guide that is used to assist in the placement of an endotracheal tube during intubation. Occasionally, the airway is tortuous and difficult to intubate. The stylet facilitates shaping the endotracheal tube to more closely match the anatomy of the airway. It is inserted into the endotracheal tube and then bent into the desired shape. care must be exercised so that the tip of the stylet does not project past the tip of the endotracheal tube. Once the stylet is correctly placed, some practitioners will make a right-angle bend where the stylet enters the endotracheal tube to prevent its further advancement down the tube. EQUIPMENT USED TO ASSIST IN INTUBATION. Yankauer Suction (Tonsil Tip) catheter is a rigid large- diameter plastic or metal catheter designed to quickly remove large amounts of liquid material from the airway (Figure 5-34). The Yankauer suction catheter should be connected to vacuum, ready and available when intubation is attempted. It is the best device to use to quickly clear an airway of secretions, blood, or vomitus. End-tidal CO2 Detection Once the endotracheal tube is placed, breath sounds are auscultated bilaterally and an endtidal cO2 detection device is placed on the airway to verify the presence of exhaled cO2. Figure 5-35 is a photograph of a colormetric end-tidal cO2 detector (easy cap) that attaches to an artificial airway. EQUIPMENT USED TO ASSIST IN INTUBATION. Smiths Medical BCI® Capnocheck® II Capnograph/Oximeter smiths Medical manufactures and portable capnograph/oximeter. This divce is a battery-powered (rechargeable battery) (Figure 5-36). The capnograph operates using side-stream sampling ,which may be used with intubated or nonintubated patients. When using with an intubated patient, an adapter is placed on the airway. The gas is then drawn into the unit, where using infrared absorption, end-tidal CO2 is measured. A plethysmographic wave form and digital reading is displayed real time on the monitor screen.  SPECIALIZED ENDOTRACHEAL TUBES 5-Endotreacheal tube JUn224 DrMohammmed Senana 43 5-Endotreacheal tube JUn224 DrMohammmed Senana 44 1- Tube with Lanz Pressure Regulating Valve Is another design that minimizes endotracheal cuff pressures. This design incorporates a regulating valve and a control balloon made of latex within the large pilot balloon (Figure 5-40). The regulation valve and balloon limit cuff pressures to approximately 30 cmH2O (22 mmHg). As additional volume is injected into the cuff, the control balloon assimilates it without transmitting additional pressure to the cuff of the tube ,Reduces risk of tracheal damage during long-term intubations. Lanz valve reduces the need for manual cuff pressure monitoring. 2- Evac Endotracheal Tube Evac Endotracheal Tube is a specialized endotracheal tube with an additional open lumen (suction lumen), which terminates proximal to the tube’s cuff (Figure 5- 42). The suction lumen has a separate suction line of its own and a fitting designed to interface with conventional suction lines. The purpose of the additional suction lumen is to evacuate secretions that pool above the endotracheal tube’s cuff when inflated and therefore reduce the risk of their aspiration. with Evacuation Lumen Convenient and safe method for suctioning accumulated secretions in the subglottic space Low VAP incidence Useful for gas sampling, airway pressure monitoring, giving drugs & jet ventilation. 3- Wire Reinforced Endotracheal Tube Tubes Soft, flexible PVC tube with spiral-wound reinforcing wire Reduced risk of kinking. Reinforcing wire is sealed tightly against bonded connector , with a tortuous airway or in a case when intubation is only possible with a smaller-diameter endotracheal tube, kinking of the tube can become problematic. endotracheal tubes can be reinforced with a heilical reinforcing wire imbedded into the PVc material. Figure 5-43 is a wirewrapped reinforced tube. These tubes are also used in surgical cases when the patient’s head is hyperexteneded or flexed, the patient is turned over following intubation and anesthesia induction, or during head and neck procedures where the airway may become compromised. 4- Oral Ring Adair Elwin tracheal Tube Oral and Nasal RAE have a preformed bend in their design (Figure 5-44). Tube is designed to remove the anesthesia/ ventilator circuit from the patient’s head or surgical field. The preformed bend allows this positioning of the circuit without the risk of kinks or disconnects. care must be used when inserting these tubes in that the bend may prevent the tube from intubating an individual with a long upper airway/ trachea. reducing risk of kinks and disconnects, Rectangular mark at preformed curve aids correct positioning. Use in Nasal surgery & Facial surgery, Ophthalmic surgery ,Prone positioning. 5- Microlaryngeal Tracheal Tube Small cuff size & I.D. and O.D. provide greater access ID of 4, 5 or 6 mm only but Cuff diameter: that of 8 mm tube Used when airway has been narrowed by a tumor or other abnormality. 6- Uncuffed Tracheal Tube Wide range of pediatric sizes Provides better fit even for premature infants. Distal tip reference lines and depth marks ,Thin, but strong tube wall provides maximum inner diameter for proper ventilation. 7- Lo-Contour Tracheal Tube Cuff lies close to the tube while deflated for better view of vocal cords Translucent white tube is easy to see in trachea Adequate cuff diameter provides low-pressure seal.. 8- Combi-tube For difficult or emergency intubation. Blind placement without laryngoscope. Unique design provides patent airway with either esophageal or tracheal placement. Reduces risk of aspiration of gastric contents. 9- Jet Tracheal Tube Features: – Magill curve – Uncuffed Includes: – Main Lumen for ventilation – Insufflation lumen permits the delivery of jet ventilation. 10- Laser – Flex Tracheal Tube Stainless steel body is airtight, flexible and laser resistant, Reflected beams from the tube are defocused to reduce accidental laser strikes to healthy tissue, Smooth surface and Magill curve minimize trauma during intubation. 11- Intermediate Tracheal Tube Excellent for oral and nasal intubations where a shorter cuff is desired Features: – Murphy tip and eye – Tip-To-Tip radiopaque line – Pilot balloon and mechanical self-sealing valve 12- Tracheal Tube Meets the guidelines of the cuff criteria. Thin cuff conforms to uneven tracheal surfaces to create low pressure seal. Large cuff diameter of 1- 1/2 times the average trachea maintains proper low-pressure seal 11- Endobronchial Endotracheal Tubes endobronchial endotracheal tubes are specialized tubes designed to intubate the left or right mainstem bronchus selectively. These are used in surgical cases where one lung is ventilated while the other is operated on or, on occasion, when differential lung ventilation is desired in the critical care setting. These tubes are large and fairly cumbersome to intubate with. Most often these tubes are inserted in the surgical setting where general anesthesia induction has been accomplished and the individual intubating the patient has optimal control and monitoring capability. Carlens Tube The Carlens tube is designed to intubate the left mainstem bronchus (Figure 5-45). 11- Endobronchial Endotracheal Tubes The tube has two cuffs: one distal cuff and another cuff proximal. The distal cuff inflates against and seals the left mainstem bronchus, while the proximal cuff seals the trachea. The carens tube has a carina hook that is designed to catch the carina upon insertion to facilitate its placement. Robertshaw Tube A Robertshaw tube is made for selective entry into either the right (robertshaw right) or left (robertshaw left) bronchus. Like the carlens tube, it too is a double-cuffed endotracheal tube (Figure 5- 46). The robertshaw cuffs selectively seal the desired bronchus (right or left) and the trachea 1/2 times the average trachea maintains proper low-pressure seal. Endotracheal Tube Exchanger Sometimes it is necessary to remove an endotracheal tube that is correctly placed, due to a cuff rupture Obstruction other complications. The endotracheal tube exchanger facilitates the removal of the endotracheal tube and replacement with a new one (Figure 5-47). Endotracheal Tube Exchanger The endotracheal tube exchanger is advanced through the existing endotracheal tube’s lumen to just past the tube’s tip. centimeter markings on the endotracheal tube exchanger facilitate this process. The cuff on the existing tube is fully deflated, and then removed from the airway while the endotracheal tube exchanger remains in place. By first passing the endotracheal tube exchanger through the replacement endotracheal tube and then advancing the tube down the exchanger into the airway, it acts like a stylet, guiding the replacement endotracheal tube into correct position in the airway. Once the tube is placed, auscultate bilaterally for breath sounds, verify end-tidal cO2, and obtain JUn224 DrMohammmed Senana 58 JUn224 DrMohammmed Senana 59 INTUBATION JUn224 DrMohammmed Senana 60 Pre-intubation Assessment and Signs of Difficult Airway INTUBATION Steps of intubation : JUn224 DrMohammmed Senana 62 INTUBATION JUn224 DrMohammmed Senana 63 INTUBATION Securing the Endotracheal Tube with Tape JUn224 DrMohammmed Senana 64 INTUBATION Ventilating Success: Way to Verification for Ventilation Success : JUn224 DrMohammmed Senana 65 INTUBATION Nasal Intubation : Nasotracheal intubation in general is the procedure of using the ET tube in one of the nares JUn224 DrMohammmed Senana 66 INTUBATION Technique of Endotracheal Intubation (in a ideal setting): JUn224 DrMohammmed Senana 67  ADVANCED AIRWAY MANAGMENAT 5 Tracheostomy TracheTracheostomyos JUn224 DrMohammmed Senana 68 5-Tracheostomy JUn224 DrMohammmed Senana 69 5-Tracheostomy :Objective * Review of Evidenced-Based Guidelines in the Care &Maintenance * Review Definition, Types of Tracheostomies & their uses * Potential Complications * Nursing Care Guidelines : - Assessment. - Suctioning. - Dressing changes. - Inner cannula changes. - Other RT considerations. - Documentation in power chart. 5-Tracheostomy Definitions: Tracheotomy : Incision made below the cricoid cartilage through the 2nd-4th tracheal rings Tracheostomy: the opening or stoma made by this incision Tracheostomy Tube : Artificial airway inserted into the trachea. 5-Tracheostomy Why does your patient have a tracheostomy? * To maintain a patent airway when the ability to do this is temporarily or permanently compromised * Bypass Obstructed airway: - Tumor - Laryngeal edema - Foreign body obstruction * Facilitate removal of secretions * Permit long-term ventilation/prevent aspiration with prolonged coma. * Decrease work of breathing---severe COPD. 5-Tracheostomy JUn224 DrMohammmed Senana 73 5-Tracheostomy Important Anatomy Thyroid cartilage notch Thyroid cartilage Cricoid cartilage Trachea Sternal notch Tracheostomy placement between tracheal rings, typically between the 2nd & 3rd tracheal rings. JUn224 DrMohammmed Senana 74 5-Tracheostomy JUn224 DrMohammmed Senana 75 5-Tracheostomy JUn224 DrMohammmed Senana 76 5-Tracheostomy Parts of a Tracheostomy 1. Flange- secured with tracheostomy ties, stabilizes the tracheostomy. 2. Outer Cannula-tube connected to flange 3. Inner Cannula- removable for cleaning 4. Obturator-a plastic guide with a smooth rounded tip that is used to guide the outer cannula during insertion 5. Cuff-Soft balloon around the end of the tracheostomy that can be inflated to allow for mechanical ventilation. SPECIALIZED TYPE TRACHEOSTOMY TUBES 5-Tracheostomy Types: * Cuffed or Un-cuffed * Fenestrated or Non-fenestrated *Disposable or Non-disposable inner cannula * ‘Shiley’ tubes with disposable inner cannulas Mini Tracheostomy. * SPECIALIZED TYPE TRACHEOSTOMY TUBES There are two main types of tracheostomy tubes: 1- cuffed and cuffless. Both cuffed and cuffless tubes are available with or without inner cannulas. Disposable tracheostomy tubes are made of PVC plastic or silicone. Reusable tubes are made of silver or stainless steel. Specialty tracheostomy tubes are also available to suit different patient requirements. Some examples are discussed below. 2- Talking tracheostomy tube. Trach-Talk Tracheostomy Tubes was designed to assist the patient to speak in a low whispered voice. With the cuff inflated, a gas line with a thumb port is connected to a gas source (air or oxygen). 5-Tracheostomy Cuffed Purpose: - Increase or improve ventilation and oxygenation - Prevent aspiration with feeding tubes, decreased gag reflex, gastro- esophageal reflux Identification: - disposable cannula - disposable cannula fenestrated - Cuff Complications - Pressure from the cuff can cause damage the trachea Necrosis - Low pressure cuffs are used - RT will inflate/deflate and monitor pressure 5-Tracheostomy Un-cuffed - Plastic or metal - Allows air to flow freely around the tracheostomy tube through the larynx - Reduces the risk of tracheal damage. Identification: - disposable cannula cuffless - disposable cannula fenestrated cuffless Which patients: - Long term tracheostomy patients - Patients who do not require a seal - - Pediatrics - - Unable to maintain seal in an emergency situation. 5-Tracheostomy Fenestration tube: - Increases airflow to larynx/ vocalisation - Cuffed or un-cuffed - These are used for weaning - Enables phonation (speaking) - The fenestrated tube can be used as such if the patient is tolerating the cuff down - To suction always use the non fenestrated inner tube for suctioning SPECIALIZED TYPE TRACHEOSTOMY TUBES 3- Tracheostomy tube with high volume-low pressure cuff. The high volume-low pressure cuff (e.g., Bivona Fome-Cuf®) uses a silicone foam material to fill the cuff. This type of foam cuff does not require manual inflation with a syringe. Rather, the self inflating nature of the foam rubber provides a continuous seal while maintaining minimal tracheal wall pressure ,tube can be inflated either by attaching the pilot port to the side port auto control airway connector (if available) or by leaving the red wing pilot port open to room air for self-inflation. The important point is to check for cuff leak or obstruction. Cuff leak is evident when the gas leak is audible and the expired tidal volume is lower than the set tidal volume. Cuff obstruction may be present when the airway pressures are higher than the baseline measurement. In both cases, the patient’s vital signs and oxygen saturation would show corresponding changes. SPECIALIZED TYPE TRACHEOSTOMY TUBES 4- Tracheostomy button. The tracheostomy button is used to maintain the stoma of a patient on a temporary or permanent basis. The button offers several advantages. Direct access to the trachea facilitates tracheal suctioning and removal of secretions. In emergency situations, the button can be replaced with a traditional tracheostomy tube without the need for another tracheotomy. The buttons are also suitable for patients who may require repeated tracheostomies (e.g., myasthenia gravis, quadriplegia). 5-Tracheostomy Inner Cannula - Allows maintenance of tube patency - Changing or cleaning the inner cannula helps to clear secretions - Can be non-disposable or disposable - At disposable cannulas come in a box and will be changed Q8 hours &PRN 5-Tracheostomy Caps and Plugs - Occlude proximal end of tracheostomy tube to permit breathing through fenestration and upper airway. 5-Tracheostomy Tracheostomy Information: What should I know about my patient’s tracheostomy: - What type is it? - What number? - Cuffed or cuff less—balloon inflated or deflated - Fenestrated/non-fenestrated? - Inner cannula disposable or reusable - Corked? For how long? What is the goal? - Is the Tracheostomy information sheet in the room and visible? 5-Tracheostomy Potential Complications Hemorrhage Obstruction Clinical Presentation: - Pneumothorax - Skin color—paller, cyanotic - Subcutaneous emphysema - Increase respiratory rate, P, - Dislodged tube BP, Decreased O2 Sat. - Use of accessory muscles, flared nostrils, - Airway obstructions - inability to lie flat Labored breathing - Infection - Clammy appearance/cyanosis - Aspiration - Decreased LOC or changes to behavior (i.e.) - Tracheal damage Distress/anxiety/restlessness 5-Tracheostomy Prevention is Key: - Tracheostomy patients are at high risk for airway obstructions, impaired ventilation, and infection as well as other complication - Altered body image, require in emotional/psychological support - Skilled and timely nursing assessment and care can prevent these complications Goals in care will include maintaining a patent airway as well as ventilation/oxygenation: - Suctioning - Humidity -Tracheostomy care & maintenance 5-Tracheostomy Documentation * A good report must be presented at change of shifts and prior to breaks * Documentation should include: * A thorough resp. assessment minimally Q4 hrs. regardless of shift, including: - tracheostomy care - changing of inner cannula - how patient is tolerating interventions - suctioning frequency - Detailed assessment of secretions, consistency, amount and color. * Patients LOC(local of conciseness * Other systems potentially compromised: mobility, skin integrity, nutrition (N/G feed) and communication. 5-Tracheostomy Scenario I Patient increasingly SOB, respirations 28, lips cyanotic, patient restless, unable to lie flat, O2 sat 89%, Tracheostomy type Fenestrated #6 What do you do? 5-Tracheostomy Interventions:- - Reassure patient - suction patient quickly and efficiently monitor O2 Sat continuously - if no improvement apply hypertonic saline 1cc & suction again - Evaluate, anxiety,O2 Sat, color of skin. - If patient has a Fenestrated tracheostomy tube. - keep a non fenestrated inner cannula of the same size close at hand. - Remove fenestrated inner cannula, Replace with non- fenestrated one and bag patient with 100% O2. - Call RT stat 5-Tracheostomy Scenario II Patient is coughing vigorously and the tracheostomy decannulates and flies across the room………. what do you do? 5-Tracheostomy Intervention:- - Do not panic this will also help keep the patient calm - Do not leave the patient, call your colleagues, Call RT stat - Assess your patient, are they in immediate distress? - Do not attempt to re-site or change the tube without previous experience - Cover the stoma with an occlusive dressing - provide O2 by face mask - Place O2 sat for continuous monitoring, keep assessing your patient. - Access the new Tracheostomy of the same size, provide to RT - Assisted ventilation may be required with chin/lift jaw thrust until help arrives Questions ?? Thank You For Attention JUn224 DrMohammmed Senana 96  Have a great day DrMohammmed Senana JUn224 97