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INFORMATION • atelectasis or lung collapse the airway, respiratory insufficiency, and stasis

A. DESCRIPTIVE TERMS • mucosal damage of secretions.

Tracheotomy: A surgical incision into the trachea for the • broncho spasm
purpose of establishing an airway. Performed in the • tracheobronchial bacterial growth • Assess the need for suctioning at least every 2
operating Psychosocial impact hours through auscultation of the chest.
room. A tube is placed in the trachea just below the 2nd and • alteration in body image
○ Ventilation with a manual
3rd • alteration in communication
tracheal ring, bypassing the epiglottis. A tracheostomy may resuscitation bag will facilitate
• risk for unmet needs auscultation and may stimulate
emergency, temporary, permanent, or prophylactic. coughing, decreasing the need for
Tracheostomy: A tracheal stoma or opening that results E. EMERGENCY EQUIPMENT suctioning.
from a These items should be kept at the patient’s bedside at all
tracheotomy. times and to be with the patient
when transported off the unit:
• Maintain sterile technique while suctioning (see
Trach: A tracheostomy site or tube is often referred to as a Procedure Guidelines 10-10, pages 234 to 236).
“trach.” This term will be used frequently in the manual. Suction equipment
Inner cannula: A “sleeve” which fits inside the trach tube 10mL syringe for cuff inflation/deflation
• Administer supplemental 100% oxygen through
and Obturator for tube now in situ
the mechanical ventilator or manual
may be removed for cleaning. Replacement trach tube in specially marked bag (one size
resuscitation bag before, after, and between
Flange or neck plate: Holds ties, prevents pressure points smaller than in situ)
suctioning passes to prevent hypoxemia.
and movement. Scissors (for post-laryngectomy patient)
Obturator: Guides the tube into position without causing Ambu bag (manual resuscitation bag) • Closed system suctioning may be done with the
trauma to tissues. Is removed Oxygen equipment (optional) suction catheter contained in the mechanical
once the trach tube is in place. Tracheal dilator set (for post-trach patient with new ventilator tubing. Ventilator disconnection is not
Cuff: Surrounds the outer cannula. Inflated (with air) inside stoma; in PAR) (optional) necessary so time is saved, sterility is
trachea to prevent maintained, and risk of exposure to body fluids is
aspiration and to seal the trach wall to allow more efficient eliminated.
Nasotracheal Suctioning
air exchange, especially with
a ventilator. Community and Home Care Considerations
Fenestration: Hole in trach tube to allow air passage for • Intended to remove accumulated secretions or
• Teach caregivers to suction in the home situation
speaking (trach tube other materials that cannot be moved by the
is below larynx, making speech with a cuffed non- using clean technique, rather than sterile. Wash
patient's spontaneous cough or less invasive hands well before suctioning.
fenestrated tube impossible). procedures. Suctioning of the tracheobronchial
Ties: Cotton tie (may or may not have Velcro attachment) tree in a patient without an artificial airway can • Put on fresh examination gloves for suctioning,
around neck to decrease be accomplished by inserting a sterile suction and reuse catheter after rinsing it in warm water.
movement of trach tube. catheter lubricated with water-soluble jelly
Decannulation: The process of weaning patient from trach through the nares into the nasal passage, down • Be aware that appropriate and aggressive airway
use. Considered once a through the oropharynx, past the glottis, and clearance will assist in preventing pulmonary
patient has a patent upper airway. Consists of straight into the trachea (see Procedure Guidelines 10-9, complications, thus lessening the need for
removal or “corking” (plugging) pages 232 to 234). hospitalization.
the tube for periods of time.
For children, nebulization is one of the easiest and
• Nasotracheal suction is a blind, high-risk most effective ways to administer asthma medicine.2
B. TYPES OF TUBES procedure with uncertain outcome. Using appropriately sized masks that fit infants, or
• Metal (Jackson) or plastic (Shiley, Portex) Complications include mechanical trauma, mouthpieces for older children and adults, patients
• Single cannula or double cannula hypoxia, dysrhythmias, bradycardia, increased simply breathe normally until all the medicine has
• Cuffed or uncuffed blood pressure, vomiting, increased intracranial been inhaled. Another advantage of nebulization,
• Fenestrated (for speaking) or non-fenestrated pressure (ICP), and misdirection of catheter. particularly for young children, is that it requires no
• Disposable and permanent special technique to get the medicine into the lungs.
• Long-term and short-term • Contraindications include: By contrast, MDIs require proper technique that may
C. INDICATIONS FOR A TRACHEOSTOMY be hard for young children to master, and in many
1. Maintain a patent airway
• bypass upper airway obstruction (foreign bodies, traumatic
○ Bleeding disorders such as cases a significant portion of the medicine does not
reach the child's lungs.3
injuries, vocal disseminated intravascular
cord paralysis, surgical edema, tumors, burns) coagulation, thrombocytopenia, Nebulizer – is a respiratory device tat delivers medicine to
2. Facilitate removal of secretions leukemia. the lungs as a fine mist.
• severe bronchitis in a debilitated patient, neuromuscular ○ Laryngeal edema, laryngeal spasm.
disease, paralysis of
chest muscles and diaphragm
3. Permit long-term positive pressure ventilation ○ Esophageal varices.
• massive chest wall trauma, respiratory failure, high lesion
spinal cord injury, ○ Tracheal surgery.
prolonged coma, neuromuscular disease
4. Prevent aspiration of gastric contents ○ Gastric surgery with high
• prolonged unconsciousness anastomosis.
5. Lung / airway / breathing centre anomalies secondary to
congenital defect ○ Myocardial infarction.

○ Occluded nasal passages or nasal

6. Improve patient comfort due to absence of endotracheal bleeding.
(ET) tube
• enables eating, speaking; increased mobility due to tube
○ Epiglottitis.

• in general, if extubation (ET) not possible, tracheotomy ○ Head, facial, or neck injury.
performed after 7 to
10 days for long-term ventilation • May cause trauma to the nasal passages.
7. Decrease work of breathing and increase volume entering
the lungs by reducing ○ Do not attempt to force the catheter
anatomical dead space if resistance is met.
• severe COPDhwlo
D. COMPLICATIONS ○ Report if significant bleeding occurs.
Immediate: • Insert a nasal airway if repeated suctioning is
• hemorrhage
necessary to protect the nasal passages from
• pneumothorax
• subcutaneous and mediastinal emphysema
• respiratory and cardiovascular collapse • Be alert for signs of laryngeal edema due to
• dislodged tube irritation and trauma.
• airway obstruction (obstruction with secretions, ○ Stop if suctioning becomes difficult
constriction of airway by ties, or if the patient develops new upper
improper tube or placement, overinflated cuff) airway noise or obstruction.
• infection (nosocomial pulmonary infection rate in patient
with a trach is 50-66%; ○ Duration of the suctioning should be
largely due to natural body defenses being bypassed by the limited to less than 15 seconds.
trach tube; infection can
Suctioning Through an Endotracheal or Tracheostomy Tube
be pulmonary, stomal)
• aspiration (secretions, gastric contents)
• tracheal damage (progressive, fistula) • Ineffective coughing may cause secretion
• dislodged tube collection in the artificial airway or
Complications associated with suctioning: tracheobronchial tree, resulting in narrowing of
• hypoxemia → dysrhythmia, hypotension, cardiac arrest