براءة
عضو جديد
عدد المساهمات : 1
تاريخ التسجيل : 16/09/2010
 |  موضوع: tracheostomy  الإثنين سبتمبر 27, 2010 10:48 am | |
|  Tracheostomy Def : A surgical opening or stoma made through the second or third and fourth cartilaginous ring of trachea    * Indication : *prolonged need for artificial airway ( more than 3 weeks ) *Acute upper airway obstruction *Chronic upper airway obstruction including obstructive sleep apnea *Intolerance to endotraceal tube *Retention of bronchopulmonary secretion *Predisposition to pulmonary secretion *prophylaxis in anticipation of acute airway management problem ( burn , radial neck surgery ) *Post laryngectomy *Congenital anomalis of the face and neck that make intubation impossible * Purpose : * Maintain patent airway * Improve patient comfort * Permit speech for the patient * Increase patient mobility * Facilitate oral nourishment * Facilitate transfer from ICU * Types: * Disposable or reusable * Cuffed or non cuffed plastic or metal * Temporary or permenant * Components : Outer tube Inner tube Flang ( wings ) Pilot cuff Inflated ballon Spaeking valve Air inlet line Tracheostomy button or cap * Tracheostomy care : Elevate head of the bed 30-40 degree unless contraindicated Change p.t position frequently Avoid excessive cough pressure Keep the O2 heated and humidified Make chest physiotherapy every 2 hours Suction only if necessary Check ventilator tubing or T-tube frequently to ensure that is no pulling on the tracheostomy tube Do all tracheostomy care procedure with aseptic technique Use the smallest possible feeding tube Check placement of feeding tube every 4 hours Monitor fluid and Wt regularly Communicate with the p.t even unconscious Keep the tracheostomy ties tight enough If the p.t has a disposable inner cannula , remove and replace it with another sterile one every 24 hrs If he doesn't have a disposable inner cannula , follow procedure for cleaning the iner cannula If tracheostomy ties doesn't have an inner cannula concentrate exclusively on wound care Keep the p.t well hydrated 2-3 litres of fluid per day uless contraindicated ( Renal disease , CHF , pULMONARY EDEMA , Increased intracranial pressure ) Clean the wound around tracheostomy tube and inner cannulaat least every 8hrs * Changing the tube : * The physician change the first tube 2-7 days after surgery The tube is changed once a week in acute setting &* about once every month or every two months for the clinic or home The acute care p.t is (NPO) for afew hours before the tube changes * Extubation : Removal of the tracheostomy when the indication for intubation is no longer present and when the p.t is able to clear his own secretion and protect the airway from secretion and protect the airway from aspiration * post extubation care : Stay with the p.t until he feels confident that he can breathe on his own without dificulty Obseve the presence of stridor , which indicate airway narrowing to less than 5 mm which can be treated with corticosteroids and reintubation as ordered Observe signs indicating laryngospasm , supraglottic edema , SIgns of aspiration and hoarsness of voiceReport immediately if there is any abnormality * Complication : Hemorrhage : May occur within 48 hrs after tube insertion Trauma : during tube insertion ( hemorrhage , s.c emphysema , thyroid gland injury , pneumothorax ) Hypoxemia : & segal nerve stimulation Stoma ifection Tracheo-esophageal fistula due to excessive cuff pressure Agitation : Arises from pain and discomfort video : | |
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