Normal tracheostomy cuff pressure
Maintain at 18-25mmHg
First 24 hours after insertion
Do not suction, refer to ENT
Bleeding risk too great
Tracheostomy complications
Infection
Pneumonia
Hemorrhage
Tracheal injury
Obstruction
Subcutaneous emphysema
Pneumothorax
Risk factors for displacement
Excessive coughing
Obesity or thick neck
Trach ties not secured properly
Agitation
Turning
Transferring
Emergency equipment in room @ all times
Replacement trach
Obturator
Sterile hemostat
Ambu bag
Suction equipment
Trach suctioning pressures by age
Infants: 80-100 mmHg
Children: 100-120 mmHg
Adults: 100-150mmHg
Complication with suctioning
hypoxemia, cardiac dysrythmias, laryngeal spasm/couch, bradycardia, nasal trauma & bleeding.
Max diameter of suction catheter
No larger than 1/2 diameter of artificial airway
Nursing interventions for client with trach
Trach care
Prevent tissue damage
Air warming and humidification
Communication
Nutrition
Trach care: dressing change procedure
Remove old dressing
Clean skin around the stoma with 1/2 H2O2
Rinse with NS
Change ties
Apply trach dressing
Assess for following every shift
Tracheal deviation
Patency of trach
Integrity of skin
Frequency of trach ties change
every 48hrs or prn
Endotracheal tube
a catheter that is inserted by a MD or specially trained personel into the trachea through the mouth or nose in order to maintain an open air passage or to deliver oxygen or to permit the suctioning of mucus or to prevent aspiration of the stomach content
Tracheostomy Tube
a small incision is made by a surgeon in the patient's neck & tube is inserted directly in to the trachea, temporary or permanent air way.
Cuff for Peds
15-20 mmHg
Obturator
guide used to insert trach tube
Hypoxia
lack of oxygen
Upper airway obstruction signs and symptoms
gurgling, restlessness, excessive oral secretions, drooling, gastric secretions, inability to clear secretions from upper airway w/ coughing
Lower airway obstructions signs and symptoms
wheezes, crackling, absent or diminished breath sounds
Yankauer
rigid suction catheter used to remove secretions and foreign material from the oral cavity
Suctioning Documentation
Respiratory assessments before and after
Type and size of trach tube
Frequency and extent of care
Care completed
Client tolerance
Any complications
amount, consistency, color, odor of secretions
Route of suctioning, patient's response to suctioning
condit
Pediatric considerations
catheters should be 1/2 diameter of trach tube, thick secretions are harder to suction b/c smaller catheters need to be used, do not push catheter more than 0.5 cm past the tip of the artificial airway, do not suction longer than 5 seconds.
Gerontologic considerations
elastic recoil & gas exchange may not be as good, capillaries may be fragile--higher risk for bleeding or damage, higher risk for bleeding if on aitiplatlet or anticoagulant.
Ambu bag
Bag used to pre-oxegenate a client (especially before suctioning and trach care)
Inner cannula
Removable inner tube within an outer tracheostomy tube that can be removed for cleaning
hyperinflation
giving the client breaths that are 1 to 1.5 times the tidal volume through the ventilator circuit or via a manual resuscitation bag