Tracheostomy

Question 1

Interventions to establish patent airway:

Answer 1

heimlich maneuver
cricothyroidectomy
ET intubation
tracheostomy

Question 2

Advantages of tracheostomy vs. ET tube

Answer 2

easier to keep clean
better oral and bronchial hygiene
patient comfort increased
less risk of long term damage to vocal cords

Question 3

Tracheostomy: Nursing Management

Answer 3

acute care: explain purpose of procedure, prepare for procedure

insertion:
- include RT
- have emergency equipment
- ensure existing IV is patent

postprocedure:

• obturator removed (keep at bedside)
• cuff is inflated
• confirm placement (auscultate, chest xray)
• tracheostomy suture in place and secured
• monitor vitals
• monitor for bleeding
• assess site and patency at least every shift
• suction PRN (pre and post hyper-oxygenation, sterile, 10 seconds only)
• humidified air (to thin secretions)
• prevent dislodgement (watch when repositioning, do not change ties for at least 24 hours after replacement -2 person task).

Question 4

What to do if accidental dislodgment occurs?

Answer 4

• call for help
• insert hemostat in opening and spread
• insert obturator ro spare tracheostomy (lubricate, insert, remove obturator)
• insert suction catheter, thread tracheostomy tube over catheter then remove suction cath)
• if you can’t insert new trach tube, cover stoma w/ sterile gauze and ventilate with BVM.

Question 5

Decannulation

Answer 5

epithelial tissue forms in 24-48 hours

opening closes in 4-5 days

Question 6

Swallowing Dysfunction

Answer 6

trach with inflated cuff interferes with normal function of muscles used to swallow

speech therapist does assessment for swallowing and aspiration risk
-if no risk found, leave cuff deflated and replace with uncuffed tube allowing for thickened liquids and soft food to be consumed