Airway Management Part III

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Airway ManagementPart III

• RET 2275
• Respiratory Care Theory 2

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Tracheostomy Tubes

• A long-term airway placed through an incision
  made between the 2nd and 3rd tracheal rings and
  inserted directly into the trachea

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Tracheostomy Tubes

• Indications for tracheostomy
• Airway obstruction due to the following
• Inflammatory disease
• Benign laryngeal pathology, e.g., webs, cysts,
  papilloma)
• Malignant laryngeal tumors
• Laryngeal trauma or stenosis
• Tracheal stenosis
• Pulmonary toilet
• Obstructive sleep apnea

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Tracheostomy Tubes

• Advantages over prolonged translaryngeal
  intubation
• Eases airway care and suctioning
• Eliminates the ongoing risks of oral, nasal,
  pharyngeal, and most laryngeal complications of
  translaryngeal intubation
• Reduces risk of tracheal extubation
• Eases tube reinsertion
• Facilitates oral communication and speech
• Improves oral, nasal, and facial hygiene

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Tracheostomy Tubes

• Advantages over prolonged translaryngeal
  intubation
• Raises patient comfort level
• Improves patient appearance
• Facilitates nursing care of the overall airway
• Improves patient mobility
• Eases disposition to long-term care facility
• Less airway resistance

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Tracheostomy Tubes

• Most experts agree that patients requiring ET
  intubation for more than 7 days should have a
  tracheostomy
• Some evidence indicates that a tracheostomy
  performed early, i.e., within 3 days of
  intubation, may decrease the risk for pneumonia,
  the length of mechanical ventilation, and the
  length of stay in the ICU.

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Tracheostomy Tube

• Outer Cannula primary structural unit of the
  tube, to which is attached the cuff and flange
• Flange prevents tube slippage into the trachea
  and provides means to secure the tube to the neck
• Inner Cannula cannula within the outer cannula
  that can be removed for routine cleaning can be
  locked in place

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Tracheostomy Tube

• Cuff seals off the lower airway, either for
  protection from aspiration or to provide positive
  pressure ventilation inflation tube leads from
  the cuff to a pilot balloon and spring loaded
  valve Tie strings stabilizes the tube at the
  stoma site - attached to the flange and is tied
  around the neck

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Tracheostomy Tube

• Obturator placed within the outer cannula with
  its tip extending just beyond the far end of the
  tube minimizes mucosal trauma during insertion
• Radiopaque Indicator helps confirm tube position
  on radiograph

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Fenestrated Tracheostomy Tube

• The fenestrated tracheostomy tube has a removable
  inner cannula. However, the outer cannula has a
  hole in it a fenstration
• With the inner cannula removed and the cuff
  deflated, the patient may breathe through the
  upper airway, via the fenestration

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Fenestrated Tracheostomy Tube

• In the event mechanical ventilation is required,
  the cuff can be inflate and inner cannula
  replaced in this configuration, the tube
  performs like a regular cuffed tracheostomy tube

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Talking Tracheostomy Tube

• Provides a separate inlet for compressed gas,
  which escapes above the tube allowing phonations

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Passy-Muir Speaking Valves
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Passy-Muir Valve

• Candidates for PMV
• Awake and alert tracheostomized (ventilator or
  non-ventilator dependent patients) adult,
  pediatric and neonatal

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Passy-Muir Valve

• Benefits
• Tracheostomized and ventilator dependent patients
  can produce clearer speech
• Improved swallowing due to increased
  pharyngeal/laryngeal sensation decreasing the
  need for tube feeding
• Decreased need for suctioning by enabling the
  patient to produce a stronger, effective cough

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Passy-Muir Valve

• Benefits
• Decreased aspiration due to increased
  pharyngeal/laryngeal sensation
• Improved weaning by improving physiologic PEEP,
  which can improve oxygenation
• Reduces decannulation time by allowing the
  patient to begin to adjust to a more normal
  breathing pattern through the upper airway
• Decreased length of stay

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Passy-Muir Valve

• Contraindications
• Unconscious and/or comatose patients
• Inflated tracheostomy tube cuff
• Foam filled cuffed tracheostomy tube
• Severe airway obstruction which may prevent
  sufficient exhalation
• Thick and copious secretions
• Severely reduced lung elasticity that may cause
  air trapping
• This device is not intended for use with
  endotracheal tubes

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Tracheostomy Button

• Used to maintain a tracheal stoma

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Tracheostomy Button

• Fits from the skin to just inside the anterior
  wall of the trachea
• Avoids added resistance to the airway
• Use
• Relieving airway obstruction
• Removing secretions
• Has an adaptor for provision of IPPB or
  mechanical ventilation

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Tracheostomy Button

• Has an adaptor for provision of IPPB or
  mechanical ventilation