Flashcards in Airways, Suctioning and Trach's Deck (20)
Why might a nasopharyngeal be used over an oropharyngeal airway?
Easier to gag out the oro type, but naso is much more secure since it does not irritate gag reflex
What sizes do oropharyngeal airways come in?
- Size 000 to 10, OR small, medium or large
- Babies and small children = 000-3
- Bigger children = 3-4
- Adults usually 4+
- Measure is based on age and size of person
Why do we do oral suctioning?
- Yaunker suctioning common
- Removes secretions from the mouth (but will also remove O2; be mindful of pre-oxygenating)
Where do we insert an oropharyngeal tube?
Inserted through the mouth to pharynx
Where do we insert a nasopharyngeal tube?
Inserted through the nares to the pharynx
What are complications of airway suctoning?
- Trauma to the airway
- Increased HR (remove O2, heart pumps harder) OR decreased HR if vagus nerve irritated
- Laryngo spasm
Describe the anatomy of the trachea:
- The trachea is the first part of the airway not shared by GI tract
- Trachea stretches between the larynx and the carina
- In the average adult it is 10-12cm long and 2.5cm in diameter (determines size of tracheostomy)
- The trachea is protected by 16-20 hyaline cartilage rings which help to maintain patency
What is a tracheostomy?
- An artificial opening (or stoma) in the trachea
- Surgically created between 2nd and 3rd cartilaginous ring
- Temporary or permanent
- Kept open by the insertion of a tracheostomy tube
- Shortens the length of the upper airway
- Decreases the work of breathing for the patient since dead space in nose/mouth eliminated, much easier for patients with labored work of breathing
Why might someone have a permanent trach?
- Cancer (esp. head and neck)
- Muscular dystrophy
- Myasthenia gravis
- May or may not be ventilator dependent
What are some general indications for trachs?
- Not usually a first line procedure, typically intubation done in other ways
- Foreign bodies
- Inability to protect own airway
- Respiratory insufficiency
- Upper airway obstruction and bleeding
- Inability to clear secretions effectively
What are some complications of tracheostomy?
- Airway occlusion
- Tissue damage (necrosis, ulceration)
- Pooling of food in airway d/t decreased functioning of epiglottis
- Communication difficulties
- Tube displacement/dislodgement (e.g. by coughing)
- Tracheo-oesophageal fistula
- Inability to maintain nutrition/hydration needs
- Air leaks
- Loss of normal airway function
- Secretion accumulation in upper airways, requiring suctioning
- Dehydration of airway
- Poor oxygenation of tissues leading to atelectasis possible
What are the different types of trach tubes?
- Vary in length, size, composition and number of parts
- Cuffed vs. uncuffed
- Fenestrated vs. non-fenestrated
- Fenestrated means there is a small hole in the tube, used to help promote speech; trachs with no trachs = no sound
- Downside of fenestration is accumulation of secretions/food in the tube, occluding the airway
Describe the composition of trach tubes:
- Consists of an outer cannula with flange [the outer wings], inner cannula (changed q12h) and obturator (mostly for insertion and new trachs at risk of stoma closing; is NOT left in there since it would occlude)
- May have a speaking valve attached (but tube must be fenestrated)
Describe nursing implications for trachs:
- Preparation (equip at bedside, pt assessment, discussed with patient, correct positioning, 2nd nurse to help with procedures)
- Assessment (airway, breathing, o2 sats, energy to breath, chest expansion, coughing, assessment of secretions, are they tolerating o2 or humidification)
- Education (family may want to learn how to suction)
- Communication/body image changes
- Guidelines and documentation
Describe patient assessment:
- Why does the patient have a tracheostomy?
- How long have they had a tracheostomy?
- Type/size of tube (think of size like straw and how appropriate it would be to easily breath through for the person)
- Level of respiratory support needed
- Respirations/breath sounds
- Humidification method?
- Suction required?/how often?
- Thickness, colour, amount of sputum
- Cleaning of inner tube?
- Wound assessment/dressing changes (once a shift)
- Can the patient swallow?
- Assessment done?
- Weaning progress
- When does the outer tube need changing?
- What does the patient look like?
- Patient education
- Mouth care
Describe patient education:
- Explain all procedures
- Pre-op education
- Communication limitations/alternatives
- Involve family
- Utilize other experts as appropriate
Describe the use of humidification:
- Humidification of air occurs in upper airway
- When a tracheostomy is formed, the upper airway is bypassed
- Humidification warms and moistens air
- Potential for fluid build-up in corrugated tubing
- Insufficient/excessive humidification
Describe dressing and cannula change basic principles:
- Positioning (semi or high fowlers); may want to be lower, but can aspirate when secretions pool
- Asceptic/clean technique
- Patient education
- Wound assessment
- Likely to use NS to clean reusable cannula's
- Typically two nurses for drsg in case of emergency and to keep trach secure (pt likely to cough during change)
What are the indications for suction?
- Visible or audible secretions
- Suspected aspiration
- Dropping peripheral O2 sats
- Increased coughing
- Reduced airflow