1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 21 Artificial Airway Care

3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Suctioning Procedure that involves the insertion of a small catheter into the airway and the application of a vacuum (sub-ambient pressure) to aspirate secretions or foreign material

4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Complications and Hazards of Suctioning Tissue trauma Hypoxemia Microatelectasis Cardiac arrhythmias Hospital acquired infection

5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Prevention of Ventilator Associated Pneumonia Elevation of the head of the bed Subglottic secretion drainage Maintenance of cuff pressures Humidification of inspired gases

6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Cuff Pressure Monitoring Must be monitored regularly to prevent tracheal mucosal damage and VAP Cuff pressures are determined by: –Minimal occlusion volume –Minimal occlusion pressure –Minimal leak

7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Tracheostomy and Stoma Care Prevent infection and preserve the patency of the airway –Keep incision clean and dry –Perform suctioning and periodic draining of secretions –Administer adequate humidification

8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Hazards and Complications of Tracheostomy Care Displacement of the tracheostomy tube Decannulation of the tracheostomy tube Infection

9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Types of Tubes Single cannula tracheostomy tube –with a disposable or removable inner cannula Single cannula fenestrated tracheostomy tube Silver Holinger tracheostomy tube Bivona foam cuff

10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Specialized Tracheostomy Tubes and Appliances Communi-Trach Tracheostomy button Kistner button Olympic Trach-Talk Passy-Muir Valve

11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Suctioning Procedure Equipment preparation Positioning for artificial airway aspiration Preaspiration patient assessment Oxygenation of the patient Nasotracheal suctioning Artificial airway aspiration Closed suction system

12 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Cuff Pressure Measurement Measured using a pressure manometer and three-way stopcock –Calibrated in cm H 2 O Posey Cufflator –Combines the functions of a syringe, stopcock, and pressure manometer

13 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Tracheostomy Care Procedure Components of tracheostomy care procedure –Physician’s order for care –Auscultate the chest –Prepare a sterile field and apply sterile gloves –Remove and clean the inner cannula –Reinsert the inner cannula

14 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Stoma Care Procedure Assess the tracheostomy tube position Remove the old dressing and ties Clean the stoma site Apply a clean dressing and new ties Reassess the tracheostomy tube position