This document provides information on tracheostomy, including the types, procedures, care, and complications. It discusses the anatomy involved in tracheostomy and describes different types such as temporary, permanent, fenestrated, cuffed, and single cannula tubes. Guidelines are provided for cleaning the inner cannula, stoma, changing the outer cannula and ties. The importance of humidification for tracheostomy patients is also highlighted.
A Tracheostomy is a medical procedure either temporary or permanent that involves creating an opening in the neck in order to place a tube into a person's windpipe.
A Tracheostomy is a medical procedure either temporary or permanent that involves creating an opening in the neck in order to place a tube into a person's windpipe.
At the end of the lecture, the students will be able to:
Define tracheostomy
State two reasons why tracheostomy tubes are inserted
Discuss types of tracheostomy tubes
Discuss the procedure for cleaning a tracheostomy tube
a. Single
b. Double
Discuss the procedure for suctioning an established tracheostomy
Tracheostomy decannulation is always challenging and this presentation address the various issues, indications, contra-indications, problems and solutions.
At the end of the lecture, the students will be able to:
Define tracheostomy
State two reasons why tracheostomy tubes are inserted
Discuss types of tracheostomy tubes
Discuss the procedure for cleaning a tracheostomy tube
a. Single
b. Double
Discuss the procedure for suctioning an established tracheostomy
Tracheostomy decannulation is always challenging and this presentation address the various issues, indications, contra-indications, problems and solutions.
detailed information about tracheostomy for the medical students , includes difinition, causes, indications, care provided, management, medical and nursing management of opening , complete care of the patient , patient teaching, family teaching and contained other detailled explanation of tracheostomy
It is the fastest and most commonly practiced approach and allows visual inspection of the supraglottic areas for foreign bodies (e.g., false or loose teeth, aspirated objects) and other obstructions (e.g., tumors). The most important consideration in oral intubation is appropriate head position.
Endotracheal Intubation For Paramedical StudentsSafiulla Nazeer
This an Presentation of ENDOTRACHEAL INTUBATION. Which Consist of Definition, Indication , Contra-indication, Equipments, Techniques, Procedure and Compliction.
Dedicated to my late professor safeer khalil whose guidance lives in our minds.professor late lady reading hospital peshawar and hayatabad medical complex peshawar
Dedicated to our late teacher professor dr umar khitab who taught us with full dedication .his legacy lives in the form of his students through out the world
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Tracheostomy
An artificial airway just below the larynx in the
trachea, bypassing the mouth and upper airway
or
A tracheostomy is the formation of an
opening( stoma) into the trachea usually
between the second and third rings of
cartilage.
4. Types of tracheostomy
A temporary tracheostomy can be formed when patients require
long term respiratory support or are unable to protect their own
airways. A tracheostomy tube will be inserted to maintain the
patency of the airway. This can be removed when the patient
recovers. A temporary tracheostomy may become long term if the
patient’s condition requires this.
A permanent tracheostomy is created where the trachea is brought
out to the surface of the skin and sutured to the neck wall. This
stoma is kept open by the rigidity of the tracheal cartilage. The
patient will breathe through this stoma for the remainder of his/her
life. As a result, there is no connection between the nasal passages
and the trachea.
This procedure is elective and the patients need to be carefully
prepared for the consequences of the procedure.
(nepian hospital sydney)
5. Tracheotomy
tracheotomy refers to the formation of a
surgical opening in the trachea. It refers
strictly to a temporary procedure.
incision of the trachea( tracheotomy)
9. Tracheotomy procedure
Neck skin over 2nd
tracheal ring identified.
vertical incision about 2–3 cm(skin)
Sharp dissection to cut the platysma
muscle
Blunt dissection parallel to the long axis of
the trachea used to spread the
submuscular tissues until thyroid isthmus
is identified
10. tracheotomy
If the gland lies superior to the 3rd
tracheal ring, bluntly undermine and
retract superiorly to gain access to the
trachea
11. tracheotmy
If the isthmus overlies the 2nd and 3rd ring
of the trachea, it must be mobilized and
either a small incision made to
clear a space for the tracheostomy.
15. Tracheal entry.
1) 2nd tracheal ring divided laterally,
anterior portion removed.lateral sutures for
countertraction.
16. Creating the tracheal portal:tracheal wall flap (Bjork flap)
2) tracheal ring not resected but instead a
flap is created which can be attached to
skin.
17. Indications of tracheostomy
To facilitate weaning from mechanical
ventilation by decreasing anatomical dead
space.
To remove retained tracheo-bronchial
secretions.
To bypass upper airway obstruction
18. advantages
reduce the upper airway dead space by up
to 150 ml (50%) reduced effort in breathing
compared to the naso- or oropharyngeal
route consequently significantly reduced
airway resistance and increased alveolar
ventilation [alveolar ventilation= tidal
volume - dead space volume.
19. disadvantages
warming, humidification and filtering of air do not take
place drying out of the tracheal and bronchial
epithelium response of epithelium increased
mucus, also increased production of mucus in response
to a foreign body (the tube) within the trachea-
Disruption to swallowing mechanismsplinting of larynx-
normal upward movement prevented
Loss of normal cough reflex and positive intralaryngeal
pressure.
20. complications
Complications of tracheostomy
Immediate (operative)
Haemorrhage, air embolism, damage to adjacent structures such
as the cricoid cartilage, pleural domes, recurrent laryngeal nerves
Intermediate (within 2 weeks)
Blockage or displacement of the tube, pneumothorax,
Neck emphysema, chest or wound infection
Delayed
Subglottic and tracheal stenosis, tracheocutaneous fistula,
Tracheomalacia, Tracheoinnominate-artery fistula,
Tracheoesophageal fistula, Pneumonia, Aspiration.
21. Types and Uses of Tracheostomy Tubes
1) Universal
double-lumen or double-cannula tube.
three parts
outer cannula with cuff and pilot tube
inner cannula
obturator
Tracheostomy tubes with an inner cannula are called dual
cannula tracheostomy tubes.
22. The outer cannula keeps the airway open
The outer cannula is placed in the stoma
to keep the hole from closing.
the inner cannula has a universal adaptor
for use with a ventilator and other
respiratory equipment.
Some inner cannulas are disposable;
others must be removed, cleaned and
reinserted.
24. Dual-Cannula Tracheostomy Tubes
An example of an inner cannula in which the 15-mm ventilator
attachment is connected to the inner cannula. If the inner
cannula is removed, it is not possible to attach the ventilator.
26. 2)Single Canula tube
Slightly longer than the universal tube.
Long or thick necks.
Requires additional humidification to
prevent the accumulation of secretions
28. 3)Fenestrated
fenestration (hole) in the middle of the upper
aspect of the outer tube (cannula).
Allows air to flow through the upper airway and
tracheostomy opening
Allows the patient to speak and produce more
effective cough
Used during weaning
32. Tracheostomy Button
Short straight tube fitting into
tracheostomy stoma after trac tube
removal.
Doesnot enter the tracheal lumen
Indications: 1) weaning because it creates
less airway resistance
2) obstructive sleep apnoea
33. Cuffed tube
On inflation seals the airway and prevents
the aspiration of oral or gastric secretions
Advantages:
1)Allow for airway clearance,
2) offer some protection from aspiration,
3) positive-pressure ventilation
35. Cuff pressure
Tracheal capillary perfusion pressure is normally 25–35
mm Hg.
High tracheal-wall pressurestracheal mucosal injury
Cuff pressure too low---- silent aspiration
cuff pressure be maintained at 20–25 mm Hg (25–35 cm
H2O) to minimize the risks for both tracheal-wall injury
and aspiration.
37. Cuffless tubes
Usually double lumen tubes
Used for long term management of
patients
Effective cough and gag reflexes to
prevent themselves from aspiration
40. Dimensions
T-tube selected on the basis of its size or
diameter.
Jackson sizes - used for Shiley
tubes(outer dia)
European standard/ISO: tracheostomy
tubes sized according to functional internal
diameter(ID) at the narrowest point.
SINGLE CANNULA TUBES: id of outer
canula tube is quoted.
41. Dual-cannula tracheostomy tubes also use the
International Standards Organization method. The ID of
the tube is the functional ID. If an inner cannula is
required for connection to the ventilator, the published ID
is the ID of the inner cannula.
most adult females accommodate a tube with an OD of
10mm, whilst a tube with an OD of 11mm for most adult
males.
42. dimensions
When selecting a tracheostomy tube, the
ID and OD must be considered. If the ID is
too small, it will increase the resistance
through the tube, make airway clearance
more difficult, and increase the cuff
pressure required to create a seal in the
trachea.
43. The sizes of some tubes are given by
Jackson size, and refers to the length and
taper of the OD. These tubes have a
gradual taper from the proximal to the
distal tip. The Jackson sizing system is still
used for most Shiley dual-cannula
tracheostomy tubes.
45. Angled versus curved tracheostomy tubes.
angled tube has a straight portion and a curved portion, whereas the curved tube has a uniform angle of curvature.
46. Tracheostomy care
Cleaning the Inner Cannula
clean at least three times a day
If sputum is thick or sticky clean it as often as
ten times a day.
Supplies
hydrogen peroxide
clean bowl
pipe cleaners or cotton-tipped swabs
54. 8. Reinsert the inner cannula into
tracheostomy and lock in place.
55. Cleaning the Stoma
Clean the skin around your stoma at least
once a day to remove sputum crusts and
prevent skin irritation.
Supplies
clean wash cloth
mild soap
cotton-tipped swabs
hydrogen peroxide
petroleum jelly
4 x 4 gauze or pre-cut dressing
58. 3. If the stoma is covered with dried
sputum crusts, remove the crusts with a
cotton tipped swab soaked in hydrogen
peroxide. Hold your breath while removing
crusts so that you do not inhale them.
59.
60. 4. If dried crusts are a problem, apply petroleum jelly
around the stoma.
5. If you do not have a problem with mucus collecting
around your stomano need of dressing.
6. If you need a dressing, buy pre-cut dressings or make
them from a 4 x 4 gauze. Do not cut your dressing. loose
fragments lodge in stoma.
61. How to Make a tracheostomy dressing
To make a tracheostomy dressing from a 4 x 4 gauze,
open gauze to an 8” x 4”size, then fold lengthwise.
64. Changing the Outer Cannula
Replace if mucus is plugging the end of the outer cannula.
Materials necessary for changing the outer cannula:
second complete tracheostomy tube with obturator and inner
cannula to replace the current one in your neck.
Water-soluble lubricants, such as K-Y Jelly® or Surgilube®.
Clean tracheostomy ties.
tracheostomy dressing
65. Changing the outer cannula
Procedure:
1. Wash your hands.
2. Prepare the clean tracheostomy tube.
a. Remove the inner cannula.
b. Attach the tracheostomy ties to the
outer cannula.
c. Place the obturator in the outer cannula.
d. Run clean water over the tubes
66. e. Apply a thick coat of water-soluble lubricant to
the outside of the clean tracheostomy tube.
3. Loosen the ties of the old tracheostomy tube.
4. With a smooth, quick motion, slide the old
trach forward and out.
67. 5. Insert the clean tube into your tracheostomy
stoma using a gentle, inward motion. If it is
difficult to insert the cannula into the stoma, lift
patients chin up. This may better align the stoma
with the hole in the trachea.
6. Stabilize the neck plate of the outer cannula
with one hand and immediately remove the
obturator with the other hand.
68. 7. Tie the neck ties to one side in a square
knot.
8. Replace inner cannula and lock in
place.
9. Wash your hands.
69. Cleaning the Outer Cannula
1. same method described as for cleaning
the inner cannula.
2. After cleansing and drying the outer
cannula thoroughly, place clean trach ties
on the outer cannula.
3. Store the cannula in a clean container
70. Changing the Tracheostomy Ties
need to be changed when they become
dirty
Ask another person to hold the
tracheostomy tube in place while changing
the ties
Supplies
½ inch wide twill tape
scissors
a friend
71. 1. Cut two strips of twill tape about 8 inches long.
72. 2. Cut a small slit at one end of each strip.
73. 3. Cut and remove the old ties while your
friend holds the tracheostomy in place.
74. 4. Pull the slit end of each tie through the
opening in the neck plate. Then, thread
the unslit end through the slit.
75. 5. Tie the ends together in a double knot to one side of
your neck. Make the ties loose enough to slip one finger
under them.
76. HUMIDIFICATION
Measures to Provide Humidity
1. Put normal saline solution into your trachea as often as needed to
keep secretions loose.
2. Keep a ten gallon humidifier in your main living area during the
day.
3. Keep a small humidifier at your bedside at night.
4. If you have radiators, place pans of water on top of them.
5. Maintain a relative humidity of 50 percent in your home.
6. The most important way to keep your sputum thin is to drink
plenty of fluids – at least six glasses of water a day.
79. humidification
Instilling Saline Solution
Supplies
clean syringe
saline solution at room temperature
tissues
1. Fill syringe with 2 cc of saline solution.
2. While breathing in deeply, squirt saline into inner cannula. This
will make you cough immediately, so have tissues ready to catch the
sputum.
3. Repeat this whenever needed to keep secretions loose.
4. Clean syringe with soap and water and dry thoroughly, then place
in a clean container.
Replace the syringe with a new one every week.
80. suctioning
Initially, a suction machine needed to clear sputum from
airway. Eventually secretions will probably decrease,
airway adjusts to the presence of the tracheostomy tube.
Supplies
suction machine
suction catheter
clean container
saline solution
connecting tubing
syringe
83. WORKING OUT SUCTION CATHETER SIZE
Size of trach. tube (mm) x 3
2
E.g. 8 x 3 = size 12
2
Suction catheter size (Fg) = 2 x (Size of
tracheostomy tube – 2)
85. `
Turn suction machine on.
Pour about half a cup of saline solution into the clean container.
Draw 2 cc of saline solution into the syringe and squirt the saline
solution into your trachea.
Wet the end of the suction catheter with normal saline
86. 7. Take three deep breaths. Then gently insert
the suction catheter 4-8 inches through your
tracheostomy tube. Do not apply suction while
you are inserting the catheter.
Once you feel resistance, withdraw the catheter
slightly
87.
88. Cover the suction control vent with your
thumb to apply suction. Do not apply
suction for more than ten seconds. As you
apply suction, gently rotate the catheter
while you withdraw it.
Do not suction more than three times a
session. If you need more suctioning, rest
at least five minutes before repeating.
Take three deep breaths after you finish.
89. Place the catheter in the water and suction to
rinse tubing.
91. TRACHEOSTOMY WEANING AND DECANNULATION
PROTOCOL
Physician orders protocol and patient meets minimal
medical criteria per protocol
Minimal criteria
1. Five to seven days postoperative, to ensure a mature
stoma, following a temporary tracheostomy.
2. No acute respiratory problems (such as pneumonia,
shortness of breath, respiratory insufficiency)
3. Minimal secretions (suctioning less than every 4-6
hours) with a strong cough reflex sufficient to clear
secretions
4. Oxygen saturation in range ordered by MD
5. Not on mechanical ventilation
6. No anatomical upper airway obstruction or limitation
92. Decannulation protocol
Deflate cuff following suction procedure
Observe and monitor patient
Cuff Deflation Successful
FAST TRACK PATHWAY
Change to cuffless and/or smaller trach and begin
plugging trial
Observe and monitor patient for 5-10 minutes
Plugging Successful
Observe and monitor patient every 2 hours for 24-48
hours
Plugging Successful decannulation
93. EXTENDED PATHWAY
unsuccessful plugging trial
Contact physician for extended tracheostomy
weaning plan:
Speaking valve (Passy-Muir)
Tracheostomy tube change to a fenestrated uncuffed
tube to facilitate speaking valve trials.
Recommendation for ENT or Pulmonary
Medicine consults in the event of recurring
trial failures.
96. Do’s:
1. Do prevent water from entering the stoma when bathing or showering.
Methods are:
Sit or stand with your back towards the shower head (face away from the shower
head).
Use a hand shower hose to avoid getting water into your stoma.
Tie a baby bib around your neck with plastic side out and terry cloth against your neck.
Drape a washcloth from your mouth.
Place your hands securely over your stoma.
2. Do wear a medic alert bracelet (if trach is long term) indicating you have a tracheostomy,
since CPR must be performed mouth to stoma and not mouth to mouth.
3. Do be careful when shaving since the neck area may still be numb and you may cut
yourself without knowing it, and be careful of the whiskers that they don’t fall into your
stoma. You should caution your hairdresser to avoid getting hair particles into your stoma.
97. 4. Do keep your stoma covered when outdoors to prevent
anything in the air from being inhaled.
5. Do remember to cover your stoma when coughing.
6. In the event of an extended power failure you may consider
one of the following:
Purchasing a generator for backup power.
Purchasing equipment with a battery backup system.
Go to your nearest hospital emergency department.
7. Keep the humidifier tubing above the level of the machine. If
water accumulates in the tubing, manually drain the water from the
tubing
98. Do Not’s:
1. Do not swim or participate in other water sports because you could
get water into your stoma and drown.
2. Do not use substances that will irritate your airway (ex: powders, hair
sprays, etc.).
3. Do not use over-the-counter antihistamines
4. Do not use Kleenex other than for coughing into or wiping sputum away
from stoma because they may shred and be inhaled.
5. It is strongly recommended that you refrain from smoking and avoid
exposure to environmental/second hand smoke.