Tracheotomy Care at home 2

Management Of Tracheotomy Care 2

Bismillahirahmanirahim, as i mentioned in my last post entry , here i will continue about the info regarding management of tracheotomy .

Endotracheal Tube Verses Tracheostomy Tube

A variety of tracheostomy tubes are available, depending on the patient’s specific needs.  Tracheostomy tubes vary in size, composition, number of parts, and shape.  Trach tubes may be made of metal, PVC material, or silicone and will differ accordingly in the degree of flexibility they provide.  They are either disposable or reusable.  

Cuffed Tracheostomy Tube

Consists of three parts:

1. Outer cannula with an inflatable cuff and pilot tube
2. An inner cannula
3. An obturator

• Cuff trach tubes are generally used for patients who have swallowing difficulties or who are receiving mechanical ventilation. 
• Disposable and reusable trach tubes are both available – and can be custom made if needed.
• The outer cannula has an inflated cuff that keeps the airway open.  When inflated, this tube seals the airway and prevents aspiration of oral or gastric secretions.  The cuff directs air through but not around the tube.  It is commonly used when mechanical ventilation is required, to provide a closed airway system.
• The inner cannula of the cuffed tube has a universal adaptor to use with a ventilator and other respiratory equipment.  The inner cannulas can be removed, cleaned, and reinserted, unless it is disposable.  The inner cannula fits inside the outer cannula.  It has a lock to keep it from being coughed out, and is easy to remove for cleaning. 
• The obturator has a rounded tip for smoothly inserting the outer tube and avoiding trauma to the tracheal wall.  It is important to keep the obturator near the beside in case of an emergency.  It is used to insert the tracheostomy tube.  
• The cuffed tube with disposable inner cannula is used to obtain a closed circuit for ventilation; cuff should be inflated when using with ventilator – just enough to allow for minimal airleak; should be deflated when/if a patient uses a speaking valve; cuff pressure needs to be checked twice daily; inner cannula is disposable.  The same aforementioned items pertain to a cuffed tube with reusable inner cannula with the exception that the inner cannula is NOT disposable – it can be reused when cleaned properly and thoroughly.

Cuffless tubes

1. Rarely used in acute care settings
2. More suitable for long term ventilation
3. Cuffless tube is usually double-lumen – patient must have effective cough and gag reflex to prevent aspiration risk

• Non-cuffed or (cuffless) trach tubes are used to maintain a patient’s airway when a ventilator is not needed. 
• Also used for patients who are ready for decannulation.  Patient may be able to eat and may be able to talk without a speaking valve

Fenestrated Tube

• Have an opening on the posterior wall of outer cannula – allows for air flow through the upper airway and trach opening;
• Allows patient to speak and produce a more productive cough
• Often used during weaning process

Used for ventilated patients who are not able to tolerate the speaking valve; there is a high risk for granuloma formation at the site of the fenestration (hole).  There is a higher risk for aspiration of secretions; it may be difficult to ventilate the patient adequately

Communication and Tracheostomies

Some trach tubes  are designed to allow patients to speak

Patients being weaned off trach tubes may have either a cuffless, fenestrated tube or a trach button that does not extend into the trachea enough to restrict airflow past the larynx

For long-term Trach patients

Speaking is possible with these options:

A fenestrated inner cannula inside a cuffed outer cannula – allows for speech when cuff is deflated (some tubes expand on inspiration and deflate on expiration versus manually deflated cuffs)

A tracheostomy speaking valve is a device that attaches to the trach tube – it contains a diaphragm that opens on inspiration and closes on expiration so that air is exhaled through the vocal cords and upper airway – the cuff must be COMPLETELY deflated during speaking valve to allow for exhalation through the upper airway

A speaking trach tube forces air or oxygen from an outside source to flow across the vocal cords, independent of the airflow within a closed system created by a cuffed trach tube.  The patient has control over this air line with a thumb port. 

will continue to Management Tracheotomy 3, wallahuaklam.