Tracheostomy care

Question 1

What are indications for Tracheostomy Care?

Answer 1

1. Obstruction of inner cannula
2. SpO2 low
3. Thick secretions
4. Increased WOB
5. with every routine monitor

Question 2

What safety equipment should you have ready for Tracheostomy care?

Answer 2

1. tracheostomy bag
2. Downsized trach
3. Obturator
4. Bagger w/pediatric mask for bagging the stoma site directly

Question 3

What equipment is used in tracheostomy care?

Answer 3

• Tracheostomy cleaning kit
• 4 Q-tips for drying (kit contains 4
  more Q-tips)
• Drain sponge (2x2)/AMD
  dressing with or without foam –
  manages moisture and bacteria
  better than drain sponge
• Normal saline
• Inner cannula (if required)
• Open suction supplies
• Pressure manometer
• Syringe 10CC
• PPE (gloves, goggle, preferably gown)

Question 4

How do you check for tube patency?

Answer 4

1. visualize the inner cannula by removing it from the pts tracheostomy and assessing the % of spoiling
2. Ability to pass the suction catheter. Confirms you don’t have a blockage

Question 5

Visualization Techniques for assessing tube patency?

Answer 5

• Preoxygenate the patient
• Remove the O2 delivering device, quickly pass suctioning catheter to assess for patency
• if unable to clear suction catheter, remove inner cannula and assess for soiling
• if inner cannula needs to be changed then switch out for another one or clean the disposable
• insert the clean/new cannula back into the tracheostomy tube
• Chart the occurrence in the patient chart

Question 6

In adults, what are the suction pressures used?

Answer 6

• Close/inline: 120-150
• open: 80-120

Question 7

What are suction pressures in children?

Answer 7

80-100 mmHg

Question 8

What are suction pressure for infants?

Answer 8

60-80mmHg

Question 9

Withdraw time for adults, kids, and infants?

• entire procedure time?

Answer 9

• A: 15-20 (30tot)
• K: 10-15 (25 tot)
• I: 5 (20tot)

Question 10

Meconium Aspirator pressure?

Answer 10

80-100

Question 11

RSBI for extubating?

Answer 11

(RR/Vt) = tobin score

• RSBI <105 is ready for extubation

Question 12

How do you determine if a Trach is cuffed or uncuffed based on the flange?

Answer 12

• Number in front of the tube indicates sizing
• CF = features outer cannula = cuffless
• FEN and LPC don’t have CF; meaning they have a cuff
• i.e Shiley CFN = cuffless fenestrated tube

Question 13

How do you determine if a trach is fenestrated based on the flange?

Answer 13

• A “N” at the end usually indicated a fenestrated tube
• A “S” indicates solid; meaning no fenestration
• i.e Shiley CFN = cuffless fenestrated tube

Question 14

Why do we use fenestrated tubes/trachs?

Answer 14

Aids in the ease of weaning

• helps patient speak while on a vent or the trach hole is covered

Question 15

What is a fenestrated tube/trach

Answer 15

Fenustrated means there is a hole towards the vocal cord

• allows the patient to speak while vented

Question 16

What does a “D” indicated on a trach flange?

Answer 16

That the tube is disposable

Question 17

Purpose of Tracheostomy care?

Answer 17

1. Maintain patency of trach tube
2. Maintain integrity of the skin and mucous membrane
3. Prevent infection

Question 18

What is involved in Tracheostomy care?

Answer 18

Stoma care and dressing changes, inner cannula care, and changing trach ties

Question 19

How often is Tracheostomy care performed?

Answer 19

After 24hrs, is done dailiy and if soiled

• long term trachs may not require a dressing

Question 20

How often are Tracheostomy ties changed?

Answer 20

After 24hrs, only when soiled

Question 21

When is Tracheostomy care require sterile procedure vs clean?

Answer 21

Sterile gloves are to be worn for the first 72 hours. After that period, normal clean procedure

Question 22

Reference

Answer 22

https://learn.sait.ca/content/enforced/612444-202320RESP-319-A/course_files/Trach%20%26%20Other%20Lab%20Materials%202018/Trach_TracheostomyCare.pdf?ou=612444

Question 23

Emergency interventions for Trachs: (add in later)

Answer 23

https://learn.sait.ca/content/enforced/612444-202320RESP-319-A/course_files/Trach%20%26%20Other%20Lab%20Materials%202018/Trach_EmergencyIntevention.pdf?ou=612444

Question 24

full ref if needed

Answer 24

https://learn.sait.ca/content/enforced/612444-202320RESP-319-A/course_files/Trach%20%26%20Other%20Lab%20Materials%202018/Trach%20Learning%20Module.pdf?ou=612444