Most common Tracheostomy Complaints Include the Following:
o Dislodgement
o Decannulation
Equipment:
o 3 parts (past photo)
o Outer cannula (rigid)
§ Top portion of the trach is called the neck plate
· On the right upper hand corner you will find all the information you need in terms of sizing
o Size 4, 6, 8 is the measurement of the inner diameter
o Inner cannula
§ Must be inserted into the outer cannula to be able to bag the patient or connect the patient to the vent
§ You do not need the inner cannula if the patient is trach to air
o Obturator
§ The most distal portion of the outer cannula is blunt and has sharp edges the obturator prevents you from causing any damage when inserting the outer cannula
Important things to know when you get a tach patient
o Size ( 4,6,8)
o Cuffed or uncuffed
o Reason for Trach
o Date of placement
o Stoma healing roughly 7-10 days
§ Increased risk of creating a fall passage if you replace the trach within 10days
Uncuffed trach are mostly used in patients to allow them to speak. If you need to ventilate a patient you must have a cuffed trach
Step-wise Management of Patient with respiratory Distress in the Setting of a Trach
o Default action for all patients in respiratory distress is to bag the face and the neck
o High flow or PPV
o How to bag the stoma if the trach is dislodged
o Pediatric BVM
o LMA (inflate a size 3 or 4 LMA and seal it around the stoma)
o Remove the inner cannula and clean it. Replace it with either a new one or the clean one
o Insert a sterile in-line suction catheter
o If you can only insert the suction 1-2cm your tube is either dislodged or obstructed
o If suctioning fails will need to deflate the cuff and push it in further and re-inflate it
o If deflating the cuff fails will need to remove the trach tube
o Can now intubate through the stoma or oropharynx
Laryngectomy patient:
o Cannot intubate through the mouth must go through the stoma
If inserting an ET tube into the stoma only go until you loose site of the cuff then stop and inflate. Very short distance the tube needs to travel for a trach compared to an oropharyngeal intubation
Algorithm
o Green Algorithm (patent upper airway)
o Red Algorithm (laryngectomy patient)
References:
o https://www.youtube.com/watch?v=szNsOtwEU8k
o https://emcrit.org/wp-content/uploads/2012/09/guidelines-trach-emergencies.pdf
o https://wikem.org/wiki/Tracheostomy_complications
o https://first10em.com/tracheostomy/