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What is the "Methylene Blue" test for?
To test for aspiration
- -oropharyngeal suctioning
- -NG tube placement
- -elevate head of bed
The "Hi-Lo Evac Endotracheal Tube with Evacuation Lumen" has an additional lumen integrated into the wall of the tubes which ends in a dorsal opening proximal to the cuff. What is this indicated for? And explain the aspiration system.
It is indicated for evacuation or drainage of secretions that may have accumulated in the subglottic space during long term intubation.
The aspiration system is an attachment for the lumen that allows for continuous aspiration or intermittent suctioning of the secretions.
What does the "Hi-Lo Evac Endotracheal Tube with Evacuation Lumen" help decrease in the hospital?
Helps decrease the rate of ventilator associated pneumonia (VAP) in the hospital.
What is the important precaution to know about the "EVAC" ?
Its important to know that it doesn't reduce/eliminate the requirements for other suctioning that is usually performed such as tracheal / bronchial, oral cavity etc.
What is the goal when measuring cuff inflation for pressure check ? and what is it estimated to range from? what are the two "cuff pressure check" techniques?
What is the minimum cuff pressure?
Goal : To keep cuff pressures below the tracheal mucosal capillary perfusion pressure
Range: 25 - 30 mm Hg.
- 1. Minimal occlusion technique
- 2. Minimal leak technique
Minimum pressure cuff is 20!!!
Cuffs should never be more than ______ or ____. When should you contact a doctor?
30 cm H20 (manometer) or 22 mm Hg (blood flow)
Contact a doctor is cuff pressure is 30 cm H20. It means they have edema.
What happens when cuff pressures are too high? or too low?
Too high : cuts off mucosal blood flow and causes tissue damage
Too low: it does not prevent silent aspiration of pharyngeal secretions, which can contribute to the cause of ventilator associated pneumonia (VAP)
What is the acceptable range for cuffs to be inflated to?
- 25-35 cm H20 (20 to 25 mm Hg)
- this should prevent mucosal injury and silent aspiration.
What measurement are most manometers calibrated to?
What is "Tracheomalacia" ?
a softening of the tracheal tissue
What 5 things are important when securing an airway/confirming placement? explain a little about each.
1. Tape, trach ties, or a holder ( this is what secures it, the balloon DOES NOT secure it)
2. Placement - x-ray (2-5 cm above carina)
3. Patient communication
4. Adeqaute humidification (30 mg/l water vapor, and short term use of HME. Use for short term or else you will start having drying and then narrowing of the airway)
5. Minimize nosocomial infections
What are the 3 important things to remember when you secure a ET tube to a patient?
1.Secure it to the cheek because that part of the face doesn't move. The jaw does move.
2. Rotate the ET tube every 8-12 hours
3. Mouth care
Airway trauma associated with Tracheal tubes:
1. What is a primary cause of injury?
2. What can help to avoid self-extubation?
3. What can help reduce tube traction?
4. Selection of the correct ____ ____ is important?
5. ______ tubes are easier to stabilize.
1. Tube movement
3. Swivel adapter
4. Correct airway size
Name 7 important things to do to provide proper airway maintenance.
- 1. Securing the tube and maintaining placement
- 2. Providing for patient communication
- 3. Ensuring adequate humidification
- 4. Minimizing the possibility of infection
- 5. Aiding secretion clearance
- 6. Providing good cuff care
- 7. Trouble shooting airway problems
Name 3 artificial airway emergencies
1. Tube obstruction
2. Cuff leaks (they wont receive proper ventilation)
3. Accidental extubaion
(if #1 or #2 happen you can use a mask to ventilate them)
What are "Manual Resuscitators" ?
Portable, handheld devices that provide a means of delivering positive pressure to a patients airway
Name the 5 parts of a Manual Resuscitator
1. Self- inflating bag
2. Air- intake valve
3. Non- rebreathing valve mechanism
4. Oxygen inlet nipple
5. Oxygen reservoir
What does the Manual Resuscitator deliver ?
Delivers room air, oxygen, or oxygen/air mixtures via mask, ET tube, or trach tube
Explain how the Manual Resuscitator directs air flow
The valve directs the flow of air or oxygen to the patient when the bag is compressed, and away from the patient and into the atmosphere on exhalation
What is the bag volume capacity for infants, pediatrics, and adults? and which ones have the 40 cm pop off ?
Infants : 250 ml ( 40 cm pop off )
Pediatric : 500 ml ( 40 cm pop off )
Adult : 2000 ml
* one hand squeeze is normally about 750 ml *
Name the first 4 "techniques" needed for Manual Resuscitators
1. Check equipment - pressure test for leaks, check valve position/ alignment
2. Make sure bag & mask are correct size for patient
3. Have suction equipment set up & ready
4. Check oxygen source (wall unit or portable tank) for obstruction of the flow, plenty of O2, and correct adapter to connect the tubing to the O2 source.
Name the last 4 "techniques" needed for Manual Resuscitators
5. Adjust flow rate according to patients need (flow rate of between 10-15 L/min should provide 90%-100% oxygen)
6. Mask ventilation (one person "E-C" technique) (two person, one hold mask, other bag)
7. Tracheostomy or ET tube, keep dominant hand on the connection between the bag and the tube
8. Compress the bag every 5 sec, delivering 12-20 breathes per minuet
You should let the bag recoil slowly to promote what ?
adequate venous return during exhalation
(rapid bagging rates and short recoil time can cause hypotension)
Why should you time the compressions when bagging a patient?
to assist the patients inspiratory effort, trying not to compress the bag when he exhales
what should you asses when bagging a patient?
the ease or difficulty with which the bag is inflated
What 5 things should you do if the patients chest doesn't rise when bagging them?
1. check mask to see if its sealed tightly
2. Confirm connection between bag and trach or ET tube is secure
3. Make sure head & neck are properly positioned
4. Check airway for patency
5. Suction if needed
What can happen if you overinflate the lungs when bagging ?
Could cause barotrauma or hyperventilation
*one hand should deliver correct amount of tidal volume
Be alert for any bagging difficulty such as : (2)
1. persistent stiffness or resistance (could mean you are in the right mainstem lung)
2. Observe, diaphoresis, hyper - or hypotension, and any changes in heart rate or rhythm
Name the 2 diaphragm type breathing valves:
Leaf - Hudson lifesaver. Respironics Disposable
Duck Bill Valve. Laerdal Hudson life saver II Life design system