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Tubes and Drains. PN 3. Respiratory Tubes. Tracheostomy. Tracheostomy. opening in trachea-surgically created Variety of tubes can be inserted-temp/perm, length of use, speak Variation of tubes-double or single lumen, cuffed or not. Tracheostomy. Comparison of features-Cannula.

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respiratory tubes

Respiratory Tubes

Tracheostomy

tracheostomy
Tracheostomy
  • opening in trachea-surgically created
  • Variety of tubes can be inserted-temp/perm, length of use, speak
  • Variation of tubes-double or single lumen, cuffed or not
comparison of features cannula
Comparison of features-Cannula
  • Double lumen-both inner and outer cannula
  • Easy cleaning
  • Reusable or disposable
  • Shiley
  • Single lumen-no inner cannula
  • Short term use
  • Not anticipated to have copious secretions
  • Portex
slide8
Cuff
  • Cuff-allows to be sealed off
  • Prevent air loss or prevent aspiration
  • Inflate with air using syringe to pilot ballon
  • No cuff-long term use
  • Don’t need mechanical ventilation
  • Low risk aspiration
fenestration
Fenestration
  • With-have holes in tube to allow air to flow between larynx and trachea
  • During weaning so client can regain ability to breath
  • Allows for speech
  • Non-no holes
  • Mechanical ventilation or for people who don’t speak
nursing responsibilities
Nursing Responsibilities
  • HOB 30 degrees
  • Ambu bag at bedside
  • Spare set, clamps at bedside
  • Humidified O2
  • TCDB
  • Respiratory Assessment q 4 hrs
  • Suction-set up and procedure
  • Inspect stoma
  • Perform tracheostomy care q 8 hrs
  • Change ties daily
  • Monitor cuff pressure q 8 hrs
  • Alternate communication devices
complications
Complications
  • Tube displacement-secure, keep spare at bedside, don’t pull
  • Tube obstruction-humidify O2, suction, TCDB, clean inner cannula
  • Tracheomalacia (dilation caused by high pressure cuffs)-monitor pressure, bleeding, air volumes, aspiration, get to uncuffed asap
  • Tracheoesophageal fistula (abnormal connection between trachea and esophagus from high cuff pressure)-Same as above but may have Gtube inserted
  • Tracheal stenosis (narrowing from scar tissue)-surgical dilation
  • Tracheal-innominate artery fistula (erosion of trachea into artery cause by pressure-monitor pressure, bleeding, pulsation in trach tube, prepare for immediate life-saving surgical repair
removal
Removal
  • Accidental
    • Before 72 hrs-bag, call rapid response
    • After 72-insert new tube, ventilate with manual resuscitation bag, assess air exchange
  • Purposeful
    • Suction
    • Deflat cuff
    • MD-cuts sutures and withdraws tube during exhalation
    • Dry sterile dressing over stoma and tape gently
    • Close over next few days but leaves scar
respiratory tubes1

Respiratory Tubes

Endotracheal tube

overview
Overview
  • Short term use-10 to 14 days
  • Keep patent airway
  • Can use mechanical ventilation
  • Long tube
    • One end-adapter for O2
    • Other end-cuff for inflation
insertion
Insertion
  • Orotracheal
    • Larger tube
    • Rapid restore of air
    • Discomfort for pt, displacement with tongue, occlusion from biting
  • Nasotracheal
    • Smaller tube
    • Increase respiratory effect
nursing management
Nursing Management
  • Check placement every 8 hrs
  • Confirm placement with Chest X-Ray
  • Mark lip line for cm to insure placement
  • Ambu bag at bedside
  • Suction as needs
  • Check respiratory every 4 hrs
  • Inflate cuff
  • Insert oral airway to prevent biting
  • Position on one side of the mouth
  • Oral care every 2 hours
  • Provide alternative means of communication
removal1
Removal
  • Suction
  • Elevate HOB-semi fowlers to fowlers
  • Deflate cuff
  • Have client inhale and remove at peak inspiration
  • Encourage to cough
  • O2
  • Monitor closely for 30 min
  • Teach they will have a sore throat, hoarse voice
chest tube insertion
Chest tube insertion

Pneumothorax, hemothorax, pleural effusions, lung abscess, post-op chest drainage (thoracotomy or CABG)

  • Why are chest tubes placed?
  • 3 types of drainage systems
    • single chamber-water seal and drainage collection in same chamber.
    • dual chamber-water seal and collection chamber separately
    • three chamber-water seal, collection drainage and suction control in separate chambers.
chest tube nursing care
Chest Tube-Nursing Care
  • Document vitals, breath sounds, oxygen sat and resp effort at least every 4 hours.
  • Tape all connections, secure to chest wall.
  • Keep chamber below chest level.
  • Check frequently for kinks or loops/ s/s of infection crepitus
  • If water seal system used, The water level should fluctuate with respiration. If it does not it may not be patent.
  • Keep device upright- monitor water level, add fluid as need to maintain 2cm water seal.
  • Measure drainage every 8 hrs marking the level
  • Keep 2 covered hemostats, bottle of sterile water and an occlusive dressing at bedside at all times.
complications1
Complications
  • Air leaks
    • monitor water seal chamber for continuous bubbling
  • Accidental disconnection
    • check all connections
    • instruct to exhale as much as possible & cough, cleanse tip and reconnect tubing
  • If tube accidentally removed..place Vaseline gauze immediately over site
  • Tension Pneumothorax
    • What can cause a tension pneumothorax?
  • When are chest tubes removed?
nephrostomy ureteral tube
Nephrostomy/Ureteral Tube
  • Position tube so it maintain patency, don’t clamp
  • Monitor urine output
  • Don’t irrigate unless ordered then use surgical aseptic technique with a max of 5 mL
  • Report if patency is not restored
indwelling urinary catheter
Indwelling Urinary Catheter
  • Insert with sterile techique, record amout of outflow
  • Position below bladder and secure to thigh
  • Accurate I and O
  • Routine cath care
  • Removal-explain to pt, empty and record, deflate balloon, withdraw while client exhales
ng tubes
NG tubes
  • Insertion
    • High fowlers
    • Measure-nose to earlobe then to xiphoid process-apply tape
    • Lubricate
    • Tilt head downward
    • Insert naris and advance upward and backward until resistance is met then rotate catheter
    • Ask to take sips of water or swallow-stop if they start to cough or reach tape
    • Tape in place
    • Can start suction but no feedings unless placement is confirmed by chest x-ray
ng nursing management
NG-Nursing Management
  • Check placement
    • Chest x-ray, check pH, insert air and listen for popping noise
    • Check every 4 hrs
  • Monitor residual
    • Prior to and regularly during feedings-q4hrs
  • Irrigate-check patency
  • Mouth care q 2 hrs
  • Monitor naris for ulceration
  • Removal
    • Remove tape, hold breath, withdraw in 1 smooth motion
nasoenteric tubes
Nasoenteric Tubes
  • Inserted in nare into stomach and passed into intestines bc the are weighted
    • Pt on rt side to facilitate passage
  • Placement checked by abdominal x-ray
    • Wait to tape until verified
  • Suction allows for bowel decompression and intestinal secretions
  • Perform abdominal assessment and measure girth
combined
Combined
  • Pressure to bleeding esophageal varices
  • Sengstaken-Blakemore tube-3 lumen-low gastric suction, balloon applies pressure against bleeding blood vessels
    • Traction is needed to maintain position of inflated balloons
    • NG tube inserted to suction secretions above balloon
  • Minnesota is similar but 4 lumens-drain secretions
combined2
Combined
  • Insertion
    • Upright position
    • Check all balloons before insertion
  • Complication
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