Suctioning, trachs, & chest tubes

  1. When is a trach used with people on mechanical ventilation?
    If they are going to be vented for over 7-10 days.
  2. What are two reasons to trach someone w/o a vent?
    Emergent situations:  epiglottitis, severe anaphylaxis
  3. Indications of when to suction
    • Dyspnea
    • decreased saO2
    • ronchi with bubbling or rattling breath sounds
    • cyanosis
    • restlessness
    • changes in pulse rate or rhythm
  4. Sizes of suction catheters to use on adults, children, and infants.
    • adults - 12-18F
    • children - 8-10F
    • infants - 5-8F
  5. Suction pressure ranges from ____ to ____ for adults.
  6. Do not apply ____ during nasopharyngeal insertion.
  7. Always ______ before and between suctioning.
    • preoxygenate
    • Give 100% O2 for 1 min to hyperoxygenate, then suction, reoxygenate and suction again.
  8. Suction should not be applied for longer than ______ seconds.
    5-10 seconds
  9. Pts with an endotracheal tube should be ____ & ____ prior to suctioning.
    hyperventilated and hyperoxygenated
  10. A sputum collection trap is called a ____
    Luki or Lukens tube
  11. Complications of suctioning
    • Hypoxia
    • Tissue trauma
    • Infection
    • Vagal stimulation (bradycardia) and bronchospasm (continuous coughing)
    • ***stop if pt becomes bradycardic
    • ***continuous sat monior & watch heart rate
  12. 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.
  13. What is the chorina?
    Where the trachea splits into the bronchi
  14. Which lung sounds indicate a need for suctioning?
    Ronchi, not crackles or wheezes. 
  15. How far do you advance the suction catheter for nasotracheal and trachs?
    • nasotracheal 8 inches
    • trachs 3-4 inches
  16. 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.
  17. 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.
  18. 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
  19. What needs to be done with a trach pt before they eat?
    Make sure the cuff is inflated while eating to prevent aspiration.
  20. If effusion is <_____ there is usually no action taken.
  21. Where are chest tubes placed?
    Into the pleural cavity.  This drains out air, blood, exudate, mixtures, and allows lung to fully inflate.
  22. What is a pleurodesis?
    A procedure that creates scar tissue, which results in he closing of the pleural cavity (adheres pleura to lung surface)
  23. What potentially life threatening condition can take place following a rapid expansion of a collapsed lung?
    Re-expansion pulmonary edema
  24. Nursing responsibilities during chest tube insertion?
    • Pain control
    • Consent
    • pt teaching prior to procedure
    • positioning - flat, supine
    • Observe and assess pt during insertion:  color, HR, RR, SaO2
    • Attach chest tube drainage system
  25. How to you confirm tube placement?
    CXR and assessment of lung expansion
  26. HOB _____ for chest tube pt.
    15-45 degrees
Card Set
Suctioning, trachs, & chest tubes
Suctioning, trachs, & chest tubes