Equipment 1 Trach Tube

passage of a specialized tube through the mouth and into the trachea.

• trach tube
• breathing tube

unconscious

dead space

• open airway
• deliver O2 and anesthetic gases
• assist ventilation (breath for them when we need to)

• red rubber tube
• vinyl plastic tube
• silicone rubber tube
• spiral tube

• cheap
• common
• opaque
• may absorb disinfectant
• dry, crack, collapse

• commonly used, clear
• less porous than rubber, less cracking
• stiffen with age - more flexible at body temp

• expensive
• smooth, flexible
• non-porous
• less irritating

• nylon or metal spiral embedded in tube
• very flexible - stylet
• less likely to kink
• very expensive

vinyl plastic tube

silicone rubber tube

• patient end
• goes into the patient
• beveled - wedge shape, less likely to occlude

• hole in tip of trach tube
• increases patient safety - give another hole to breathe through just in case the orginial hole gets blocked
• more surface to breathe through

has no hole in it

• machine or circuit end
• stays outside the patient
• connects to anesthetic equipment

• width (in mm)
• ID (internal diameter)
• written on the side of the tube

• cats: 3.5
• dogs: 9.0

blows up to create an air tight seal between tube and inner linning of trachea

• prevents vomit from getting in the lungs
• anesthetic gas stays in the patient and does not get into the room
• patients won't breathe in room air which will dilute anesthetic gas

no

very small patients and avian patients

no

it is tied

can cause pressure necrosis (tissue dies)

• thick walled, red rubber
• high pressure over a narrow band in trachea
• damage is possible if it is used for too long

• thin walled, clear plastic
• low pressure over a wide band inside trachea
• less likely to cause pressure necrosis

inject air with syringe

• self-closing
• plug
• clamp shut

determines how much pressure is in the cuff.

• open airway
• efficient administration of O2 and anesthetic gases
• assisted breathing
• less room air pollution with waste anesthetic gases
• prevents aspiration
• reduces dead space

air passages inside body where no gas exchange takes place

• mouth
• nasal passages
• pharynx
• larynx
• trachea
• bronchi
• bronchioles
• basically everything but alveoli

• increased efficiency
• have to move less gas to get new gas to alveoli
• less effort to breathe

parasympathetic stimulation

• bradycardia
• low blood pressure
• cardiac arrhythmias

atropine

• pharynx
• larynx

• improper positioning
• brachycephalics
• improper size (too big)

vocal cords close when they are touched

cats

• lubricate tube
• apply lidocaine to vocal cords
• place tube during inhalation

placing tube when unable to see or palpate larynx

• passes into 1 bronchus which only will ventilate half of lungs
• unpredictable anesthesia
• increases dead space
• more likely to kink

trim the adaptor end of the tube

• foreign body (blood, saliva, vomit)
• kinked or twisted
• mouth gag

pressure necrosis of lining of trachea

• cuff too tight
• "dragging" - removing tube without deflating cuff

• cough
• slough
• scar
• stricture (narrowed trachea after healing and makes it difficult to breath or intubate again in the future)

• removing without deflating cuff
• remove too soon
• not removed soon enough

passing pathogens from one patient to the next

• disinfect thoroughly
• discard if it is used with a patient who has a contagious disease

yes

• gastric dilatation
• pressure on lungs

• anesthesia
• catheterization
• intubation

• inspect tube to make sure it is clean, doesn't have any holes, blockage and to make sure it isn't too worn
• inspect cuff to make sure it is intact and can hold air pressure
• make sure we have the proper length and width for the patient

• the tip end should be halfway between the larynx and thoracic inlet (about point of shoulder)
• the adaptor end should be about 1 - 2 cm beyond incisors

distance between nostrils

• lubricate tube
• induce anesthesia
• intubate with patient in sternal recumbency and head slightly stretched out

• sternal recumbency
• extend neck, raise head
• open mouth wide, pull out tongue

lights up inside mouth so you can see the trachea opening

match curve of tube to curve of neck

wire - stiffens floppy tube for control of tube tip

remove it

doral to tracheal opening

• visualize: see it go in, patient will cough
• palpate neck: can feel the tube if it is in the esophagus
• breathing: feel exhaled breath, see condensation, see bag move
• vocalizing patient: if patient starts to vocalize then tube is not in the right place

tie gauze around tube then around muzzle behind canines or around back of the head

pull tube when patient starts to lick, chew, swallow

• clear plastic tube
• red rubber tube

spiral tube

tip end (patient end)

adaptor end

deflated

inflated

cuff inflation line

inflated pilot balloon

laryngoscope

laryngoscope blades

right way

wrong way

right way

wrong way

perfect

not far enough in

too far in

tube is too long and there is too much out of the mouth...needs to be cut

low pressure

high pressure