11. 2. Airway Clearance:
clears the secretions that cannot be cleared due to
weakness and conditions requiring long term airway
support, like progressive neurological conditions such as:
Severe brain injury ….ect
13. What is considered Long Term
Intubation for an adult and pediatric
patient???
Adult: Intubated more than two weeks.
Pediatric: Intubated more than 3-4 weeks.
16. temporary voice loss.
loss of the airborne particle
filtration, warming and humidification
action of the nose.
potential impairment of swallowing.
Mucociliary transport and cough
mechanisms are impaired.
17. How is a Tracheostomy performed?
IN 2 WAYS :
1-SURGICAL {OPEN (ST)}
(ENT) SURGEON, OR A THORACIC SURGEON.
2- PERCUTANEOUS PERCUTANEOUS DILATATION
TRACHEOSTOMY (PDT) IS DONE USING PERCUTANEOUS DILATATION
TECHNIQUE.
18. Surgical tracheostomy performed in
patients with:
1. Tumors of the upper airway
2. Previously failed/difficult percutaneous procedure
3. Major vascular structures at risk
4. Anatomical abnormality (e.g. goiters)
5. Short neck
6. Morbid obesity
7. Emergency airway
19. Goiters is a swelling of the thyroid gland, which can lead to a swelling of the neck or larynx (voice box)
20. Nursing Considerations
In (ST), the pt may come back with stay sutures
around the tube - to hold or manipulate the operating area.
In ST sutures are removed after the first
tracheostomy tube change - 5-7 days of the
insertion, while the stoma is forming or as
ordered by the operating surgeon.
22. Percutaneous
insertion:
The first tube change should
not be performed before 2
weeks of the initial insertion??
because the stoma is very tight
and the risk of the tracheotomy
collapsing is high.
23. Holistic Nursing Considerations
During the first 2-3 days…the patient is
uncomfortable due to
trauma of surgery, pain of a fresh
incision, choking, presence of a foreign object
in his trachea and inability to communicate
through speech.
24. keep in mind .. the
patient is more than a
“trach tube!”
1- pain management.
2- reassurance.
3- education
25. What are the risks involved in
tracheostomy?
1-Reactions to medication and
anesthesia.
2-Uncontrollable bleeding.
3-Respiratory problems.
4-Possibility of cardiac arrest.
26. What are the complications of a
Tracheostomy?
Early ( Life-threatening ) Late
Infection :
Accidental tube displacement 1- stoma site
2- chest-
50-60% of tracheostomy patients may
develop nosocomial pneumonia
Blocked tracheostomy tube
Skin breakdown
Damage during surgery - possible
hemorrhage. Tracheal stenosis
Sx emphysema Tracheo-esophageal fistula :
1- Abdominal distention
Trauma 2- Liquid food suctioned through
tracheostomy tube.
Pneumothorax
28. Parts of Tracheostomy Tube
Part Main features
Outer canula Main body of the tube
cuff A balloon at the distal end of the tube, provide
seal between the rachea & tube
Pilot balloon External balloon connected to the inflation line to
the internal cuff ( vice versa)
Flange/ neck plate Support the main tube structure.
Tube type, size & coude
Introducer/ obturator Bevel, smooth rounded dilating tip tipped placed
inside the inner canula of the tube during insertion.
( reduce the risk of trauma ) removed once the
tube in correct placement
15 mm adaptor Allow attachment to ventilation equipment/ ambu-
bag
29. Types of tracheostomy tubes
Single lumen:
- Larger inner diameter than double lumen
tube.
- Absence of removable inner cannula.
Double lumen:
- Removable inner cannula (twist-lock
connection ) prevent build up of secretion.
30. Cuffed t.t
indication contraindication
Risk of aspiration Child < 12 years old
Newly formed stoma ( adult ) Risk of tracheal tissue damage from cuff
PPV
Unstable condition
31. Indication
cuff cuffless
Minemiz aspiration No risk for aspiration
Allow PPV ( one way valve ) Pt no longer need PPV
Close system ( upper & lower airway ) Pt still need airway access
Minemiz emphysema
32. Indication Close Suction System:
- Pt regyuireing Highy PEEP, Fio2
- TB, ARDS
- To Avoiding dramatic drop in oxygen.
33. Fenestration:
Single or multiple holes in the superior
curvature of the shaft of outer and inner
cannula.
Indication:
- Improve speech & swallowing function.
34. Occlusion cap:
Soolid piece of plasticc can be placed
on the end of a 15mm hub.
Indication :
Blocks all air flow via tracheostomy
(end stage weaning )
35. Humidification:
1- pt requiring oxygen with excessive
secretion/bedridden ( continuous ATM ) with need
to be labeled, dated and changed as per PP.
2- alert mobiles pt with minimal secretion ( HME )
change Q 24hr.
3- buchannan bib ( contains a special foam
(hydrolox) which act as filter & HME. Shoud by
Change/washed up to 3 use’s only.
37. Condition of tracheostomy dressing wet/dry
Stoma site should be observed for:
- Bleeding
- Increase stoma size
- Appearance of stoma edges and tissue
( e.g. maceration, cellulites)
- Evidence of infection (purulent discharge, pain,
offensive odor, tenderness
- Allergic reaction to dressing product
- Tube secured to skin, ties are appropriately tight
Patient on oxygen: TM T-piece, humidification -
method.
38. Suctioning
Indications for Suctioning
if pt have one or more of the following :
Excessive secretions
Decreased oxygen saturations
Tachypnea , bradypnea or tachycardia
Restlessness, increased use of intercostal
muscles, or sweating
Noisy breath sounds/decreased breath
sound
Poor ineffective cough
Change in skin color from baseline
Reduced expired air flow from tube
during expiration
Collection of sputum specimens
40. Prior to section:
- hyperventelation
- hyperoxygenation
to Reduse Hypoxemia.
41. Caution:
COPD: patients should
only have 20% increase
of oxygenation.
Hyperventelation , will
be used for non-
spontaneous breather,
as it may have significant
adverse effects .
Ex: Reduced venous
return and barotraumas