منتدى طلاب جامعة الحديدة

أخي الزائر إن لم تكن عضواً في المنتدى فنحن ندعوك لكي تنظم إلينا وشكراً تحيات مدير المنتدى طارق البغوي
منتدى طلاب جامعة الحديدة


    Tracheostomy

    شاطر
    avatar
    عاشق فلسطين
    عضو نشط
    عضو نشط

    ذكر
    عدد الرسائل : 65
    العمر : 31
    البلد : فلسطين
    القسم والمستوى : بكالوريوس تمريض
    المزاج : عالي جدا
    أختر علم دولتك :
      :
    السٌّمعَة : 0
    نقاط : 236
    تاريخ التسجيل : 08/09/2009

    بطاقة الشخصية
    تخصصي: تمريض
    المحافظة: الحديدة

    Tracheostomy

    مُساهمة من طرف عاشق فلسطين في الإثنين أكتوبر 04, 2010 2:01 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 voice
    Report 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


      الوقت/التاريخ الآن هو الثلاثاء يوليو 17, 2018 8:00 pm