Respiratory Update for SCC Nursing Faculty - PowerPoint Presentation

Slide1

Respiratory Update for SCC Nursing Faculty

Tracheostomy Tubes and their Care

Presented by Cynthia Fouts

June, 2012Slide2

Learning Objectives:

After viewing this presentation, the learner will be able to:

Identify different types of tracheostomy tubes

Identify parts of a tracheostomy tube and their purpose

Demonstrate the correct steps in providing tracheostomy care

Recognize

the steps to perform sterile suctioning of the patient’s airway via a tracheostomy.Slide3

Tracheostomy Facts

defined as a surgical introduction of a tube into the trachea

bypasses the upper airway and thereby bypasses the normal functions of humidification, warming, and filtering of air

placed for the following reasons

to bypass an obstruction

provide airway for mechanical ventilation on a long-term basis

maintain an open airway

provide access for removal of secretionsSlide4

Placement of a Trach TubeSurgical tracheotomy – performed in the operating room under general anesthesia

Percutaneous dilatational tracheotomy (PDT) – done at the patient’s bedside under local anesthesia and sedation.Usually placed at the 2nd or 3rd

tracheal ringSlide5

Post-procedural caremost patients report feeling like they are “choking”

ensure that the patient has enough humidity and fluids to keep secretions thinkeep manipulation of the trach tube at a minimum to keep from dislodging the new tubedo not change trach ties for the first 24 hoursany trach changes necessary during the first week MUST be performed by a physicianSlide6

Types of Tubes

Silver JacksonStandard Cuff TubeFlexible TubeFenestrated TubeFoam Cuff TubeUncuffed TubeSpeaking Trach Tube

Extended Length TubesSlide7

The Jackson tube is the oldest tracheostomy tube. It is made of silver, and therefore very rigid. There is not a connection to be used with mechanical ventilation. This type of tube is not often seen in use anymore.Slide8

The low-pressure cuffed tracheostomy tube is the most common tube seen in use. It has an inner cannula which may be disposable or non-disposable.Slide9

The flexible trach tube is also referred to as a reinforced trach tube. It is not preformed, thus allowing it to conform to any anatomical configuration.Slide10

The fenestrated tube is useful in assessing how well the patient will do when

decannulated. Like a non-fenestrated tube, it has an outer and inner cannula. When the inner cannula is removed, the cuff is deflated, and the tube is capped, the patient is able to breathe through his upper airway.Slide11

The foam cuff tracheostomy tube has a cuff which is filled with foam. Leaving the cuff open to the atmosphere, air fills the foam to expand until it reaches the inside of the trachea. This minimizes tracheal necrosis and stenosis. It is important to choose the correct size prior to insertion to ensure good contact with the tracheal wall.Slide12

The uncuffed tracheostomy tube are used primarily in infant and pediatric patients. The anatomical differences in younger patients make tracheal stenosis more of a problem with cuffed tubes. Uncuffed tubes may also be used in adult patients who require an airway but not mechanical ventilation.Slide13

The speaking tracheostomy tube allow mechanically ventilated patient to orally communicate. A separate flow of gas at 4-6 L/m is directed through the larynx via a thumb port the patient occludes. The cuff around the trach tube stays inflated, separating mechanical ventilation from speech.Slide14

Extended length tubes are available to fit all anatomical configurations. The length may be extended proximal or distal to the curve.Slide15

Parts of a tracheostomy tube:

Outer Cannula – stays in all the timeInner Cannula – removed for cleaning or replacement

Obturator – used to insert the trach tube

Neck flange – has product information and holes for securing neck ties

Connector – part that sticks out to connect to ventilator tubing, a resuscitation bag, or a speaking valve

Cuff – balloon that is inflated to form a seal against the tracheal wall

Pilot tube and balloon – used to inflate the cuff by securing a

luer

lock syringe to end Slide16

Maintain airway patency

Promote cleanlinessPrevent infection

Prevent skin breakdown

Why perform tracheostomy care?Slide17

Assess for excess secretions

Soiled tracheostomy dressing and tiesAssess respiratory status

Identify type of tracheostomy tube

Assess client’s ability for self-care

Identify factors that influence tracheostomy care

AssessmentSlide18

Supplies needed for trach site care:

sterile gloves

sterile gauze

cotton tip applicators

normal saline solution

hydrogen peroxide

clean ties or tube holder

trach dressing

container to mix normal saline solution with hydrogen peroxide

Trach care kits contain any combination of the above.

Also have a manual resuscitator and suction equipment

and supplies

available.Slide19

Wash hands and don gloves

Explain procedure to patientPlace patient in Fowler’s

position

Hyper-oxygenate the patient

Suction the tracheostomy

tube if needed

Discard soiled tracheostomy dressing

Replace oxygen/humidity on the patient

Gather supplies

Tracheostomy Care ProcedureSlide20

Tracheostomy Care Procedure, cont’d.

Visually inspect the stoma for sign of infection or skin breakdown.

Using sterile gauze or cotton applicators moistened with normal saline solution, begin at the top of the trach and clean the area around the stoma, moving in one direction away from the stoma.

Hardened, crusty secretions can be teased loose with a sterile cotton-tipped applicators moistened with normal saline solution.

Clean the outside of the flange and tube connector.Slide21

Do

not use hydrogen peroxide unless there are signs of an infection. If necessary, dilute hydrogen peroxide with saline in

a 1:1 ratio.

Place

a clean tracheostomy dressing under the

flange

Replace

the tube holder/ties with clean

holder/ties

using the buddy system. The trach should always have someone holding it in place until resecured by the holder/ties.

Reassess patient breath sounds and air movement

Remove gloves and wash hands

Document

Tracheostomy Care Procedure, cont’d.Slide22

Please follow the link below to watch a very good video of trach suctioning and trach care. One point to keep in mind is, although the nurse in the video is replacing a disposable inner cannula, some tracheostomy tubes have non-disposable inner cannulas which need to be

cleaned with a hydrogen peroxide/normal saline solution, rinsed and replaced.

http://www.youtube.com/watch?v=gtKc9pe9HCw&feature=relatedSlide23

These supplies must be available in the

trached patient’s room at all times:

n

ew trach tube

obturator to replace dislodged tube

bag/valve/mask assembly

suction equipmentSlide24

Bibliography

Hess, D. et al. (2012) Respiratory Care Principles and Practice

, 2

nd

Ed. Sudbury, MA: Jones and Bartlett Learning LLC., pg. 402-415

Nancy-Floyd, B. (2011). Tracheostomy Care: An evidence-based guide to suctioning and dressing changes.

American Nurse Today,

Vol

6. No. 7. Retrieved from

http://www.americannursetoday.com/article.aspx?id=8022&fid=7978

Tracheostomy Care, (2007)

UPMC. Retrieved from

http://www.upmc.com/patients-visitors/education/documents/tracheostomycare.pdf

Update on Tracheostomy Care (2004).

RN.com.

Retrieved from

http://www.rn.com/getpdf.php/615.pdf