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Upper Airways - Terms

Upper Airways - Terms. Endotracheal Intubation (ETT) Oral-tracheal Naso-tracheal Tracheostomy (trach). Indications for Tracheostomy. Ineffective Airway Clearance r/t upper airway obstruction Inability to remove secretions congenital abnormality Severe neck or mouth injuries

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Upper Airways - Terms

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  1. Upper Airways - Terms • Endotracheal Intubation (ETT) • Oral-tracheal • Naso-tracheal • Tracheostomy (trach)

  2. Indications for Tracheostomy Ineffective Airway Clearance r/t • upper airway obstruction • Inability to remove secretions • congenital abnormality • Severe neck or mouth injuries Ineffective Breathing Pattern • Long-term mechanical ventilation

  3. Desired outcomes of suctioning • Maintain a patent airway • Demonstrate a reduced work of breathing • Stimulate cough reflex • Prevent aspiration of blood & gastric fluids • Prevent infection & atelectasis

  4. Basic Principles • Sterile technique • hyperoxygenation and hyperinflation • Keep it short • Adult: <15 sec • Peds: <5 sec

  5. Indications for Suctioning(CMs lower airway obstruction) • Hear secretions in airway • Inspiratory wheezes, expiratory crackles • Restlessness, esp. when accompanied by decreased O2 saturation • Decreased LOC/change in mental status • Ineffective coughing • Tachypnea • Tachycardia or bradycardia • Diminished ability to cough up secretions • Client asks

  6. Nursing Care (critical elements) • Assess q2h, Suction prn • Sterility • Systemic hydration, humidification of inspired air • Safety measures – prevent decannulation • Obturator & new trach at bedside • Cuff – minimal pressure

  7. Technical Considerations • Duration < 15 sec • Preoxygenate • Rest between passes • No suction when going in • Intermittent suction coming out • Appropriate catheter size & length • Saline lavage – controversial!!! • Replace supplemental oxygen

  8. Which Catheter?How Much Suction? Suction(mm/Hg) • Adult 100-120 • Infant/Child: 50-75 (Craven & Hirnle) • Neonate: 60-80 (McKinney) Catheter Size • 5-14 French • ½ diameter of trach tube

  9. Inner Cannula-disposable • Purpose: secretion accumulation can cause obstruction • Get replacement inner cannula • Non-sterile glove • Usually suction first • Usually once/day • Remove old • Put in new, and tighten

  10. Site Care • Usually once/shift • NS or ½ strength H2O2 • Clean inferior portion under faceplate, then superior section • Rinse H2O2, then dry. • Pre-cut dressing

  11. Risk for Infection • Hospital-acquired pneumonia • Stoma infection • Interventions:

  12. Risk for airway obstruction • r/t thick secretions or mucus plug • cuff overinflation

  13. Accidental decannulation • Forceful cough • While changing trach ties

  14. Tracheal wall necrosis or stenosis • Overinflation of cuff • Long term cuff against tracheal wall • NG tube

  15. Other complications Subcutaneous emphysema • Air in subcut tissues • Not dangerous: watch for increase • Inform MD if new Ineffective Communication • Word board • Often can write • Allow time – frustrating! • “talking trach”

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