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 Upper airway functions bypassed when patient has tracheotomy performed.

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Presentation on theme: " Upper airway functions bypassed when patient has tracheotomy performed."— Presentation transcript:

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2  Upper airway functions bypassed when patient has tracheotomy performed.

3  Heat/moisture exchange  Thermoregulation  Gustation (taste)  Olfaction (smell)  Filtration

4  Altered or loss of voice  Speech & language delays (young children)  Loss of smell & taste  Compromised nutritional status  Impaired swallowing/increased risk of aspiration  Secretion control issues/infection  Psychological distress  Loss of physiologic PEEP

5  Absence of airflow often creates  Frustration  Anxiety  Psychological distress  For children: delayed speech & language development

6  Absence of airflow decreases sensations  Smell  Taste  Poor appetite  Skin health  Supplemental feeding  Difficulty swallowing  Risk of aspiration

7  Cuffed trach tubes anchor larynx & sometimes interfere with:  Laryngeal elevation  Epiglottic inversion  Airway protection Cuffed trach tubes secure larynx, Deflated cuff: more freedom.

8 Three phases of normal swallowing: 1) Oral phase 2) Pharyngeal phase 3) Esophageal phase

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12  Normal swallowing (pharyngeal phase):  Oral & nasal cavities sealed  Vocal cords close  Positive pressure generated below cords  Air prevented from entering larynx  Larynx elevates & moves forward  Acts as a lever (mechanical event)  Epiglottis seals larynx  Food/liquid directed into esophagus

13 Swallowing with Trach Tube Inserted:  Vocal cords close  Air flows through trach tube  No subglottic positive pressure  Reduced sensations in larynx & pharynx  Pooling of airway secretions  Increase risk of aspiration Most patients OK!!

14  Absence of upper airway airflow (inability to nose-breathe) compromises:  Heat/moisture exchange  Increased secretion viscosity  Increased secretion volume  Frequent suctioning  Increase risk of airway trauma/infection  Presence of trach tube stimulates secretions

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17  With cuff inflated:  No physiologic PEEP  Possible micro-atelectasis  Decreased alveolar ventilation  Compromised oxygenation

18 Cuff deflatedCuff inflated Physiologic PEEP Present Physiologic PEEP Absent

19  Inspect stoma daily: irritation/inflammation.  Tracheostomy care is done every 8 to 12 hours and PRN.  Avoid dressings trapping moisture.  Check secretions: white & clear; greenish-yellow  Odor often indicates infection.  Assess need for suctioning q2h.

20 TRACHEOSTOMY CARE  Signs of Infection:  Yellow or green secretions (pink or blood-tinged)  Thicker mucus  Greater volume of mucus  Stoma site bleeding  Foul odor from stoma  Febrile patient  Pulmonary congestion  Increased RR  Listlessness  Discomfort with trach/tender stoma site

21 PROCEDURE

22 1. Loosen inner cannula. 2. Hold outer cannula with one hand. Turn inner cannula to right with other hand to unlock.

23 3. Remove the inner cannula by steadily pulling it down and toward your chest until it is out.

24 4. Place inner cannula in the solution of hydrogen peroxide & normal saline, and don sterile gloves.

25 5. Use trach brush, or pipe cleaner, to clean inner cannula of mucus and dried secretions.

26 6. Place it in bowl of normal saline (NS). 7. Shake off excess NS. Moisture will act as lubricant during inner cannula reinsertion.

27 8. Reinsert inner cannula, keeping curved portion facing downward.

28 9. Lock inner cannula into position. 10. Wash bowls thoroughly and allow to air dry. Soak trach brush soak in hydrogen peroxide-NS solution &, rinse with NS. Air to dry. Discard pipe cleaners.

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30 Goal: maintain cuff pressure below tracheal mucosal capillary perfusion pressure which is: 25 to 30 mm Hg. Cuff pressure maintained: 20 to 25 mm Hg, or 25 to 35 cm H 2 O Higher cuff pressures  Cut off tracheal mucosal blood flow  Tracheal wall damage (necrosis/tracheomalcia)

31  Caregivers must receive CPR training.  Suction if indicated.  Change trach tube if clogged.  Spare tubes (cuffless &/or cuffed): same size & 1 size smaller  Pinch nose & mouth (cuffless trach).  2 breaths with manual resuscitator/mouth-to- trach/mouth-to-stoma: STOMA LEAK  Mouth-to-mouth/bag-mask with finger over stoma: STOMA LEAK

32 Fenestrated:  Weaning  Speech Granuloma formation Increased risk of aspiration

33  Some space around tube  Snug fit: tube too large  non-fenestrated: poor or no speech

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36  Use extreme caution with baths and water  No swimming  Avoid powder, talc, chlorine bleach, ammonia, aerosol sprays, or colognes and perfumes  Prevent foreign objects from entering trach tube

37  Avoid dust  Avoid sand and beach  Watch play with other children to assure toys, fingers or other foreign bodies are not put into trach and trach is not pulled  No contact sports  Frequent hand washing

38  Teach airway anatomy  Teach about equipment  Teach CPR  Teach infection control  Teach humidification  Teach suctioning  Teach about speaking valves/fenestrated trach tubes  Teach communication through speech therapy


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