When is a trach used with people on mechanical ventilation?
If they are going to be vented for over 7-10 days.
What are two reasons to trach someone w/o a vent?
Emergent situations: epiglottitis, severe anaphylaxis
Indications of when to suction
- decreased saO2
- ronchi with bubbling or rattling breath sounds
- changes in pulse rate or rhythm
Sizes of suction catheters to use on adults, children, and infants.
- adults - 12-18F
- children - 8-10F
- infants - 5-8F
Suction pressure ranges from ____ to ____ for adults.
Do not apply ____ during nasopharyngeal insertion.
Always ______ before and between suctioning.
- Give 100% O2 for 1 min to hyperoxygenate, then suction, reoxygenate and suction again.
Suction should not be applied for longer than ______ seconds.
Pts with an endotracheal tube should be ____ & ____ prior to suctioning.
hyperventilated and hyperoxygenated
A sputum collection trap is called a ____
Luki or Lukens tube
Complications of suctioning
- Tissue trauma
- Vagal stimulation (bradycardia) and bronchospasm (continuous coughing)
- ***stop if pt becomes bradycardic
- ***continuous sat monior & watch heart rate
Evaluation and documentation after suctioning.
- Reassssment of resp system-breath sounds, SaO2, rate and depth, skin color, changes in VS
- They should be able to breathe easier, lung sounds should be clearer.
What is the chorina?
Where the trachea splits into the bronchi
Which lung sounds indicate a need for suctioning?
Ronchi, not crackles or wheezes.
How far do you advance the suction catheter for nasotracheal and trachs?
- nasotracheal 8 inches
- trachs 3-4 inches
If trachea gest dislodged what is your immediate reaction?
Cover with occlusive dressing, vasoline gause. If you do not do this they are at risk for pneumothorax.
What do you need to document with subQ emphysema?
Document the exact area you detect the subQ emphysema. Gives a baseline so you can tell if the problem is ongoing and spreading.
Which types of tubes are pts able to talk?
- fenestrated tube
- talking tube
Allows air to flow up from the trach allowing pt to talk
What needs to be done with a trach pt before they eat?
Make sure the cuff is inflated while eating to prevent aspiration.
If effusion is <_____ there is usually no action taken.
Where are chest tubes placed?
Into the pleural cavity. This drains out air, blood, exudate, mixtures, and allows lung to fully inflate.
What is a pleurodesis?
A procedure that creates scar tissue, which results in he closing of the pleural cavity (adheres pleura to lung surface)
What potentially life threatening condition can take place following a rapid expansion of a collapsed lung?
Re-expansion pulmonary edema
Nursing responsibilities during chest tube insertion?
- Pain control
- pt teaching prior to procedure
- positioning - flat, supine
- Observe and assess pt during insertion: color, HR, RR, SaO2
- Attach chest tube drainage system
How to you confirm tube placement?
CXR and assessment of lung expansion
HOB _____ for chest tube pt.