What is endotracheal intubation?
What does it provide?
What are 2 indications?
Is it long-term or temporary? How long?
Insertion of tube into mouth or nose passing through pharynx and vocal folds into trachea
Artificial airway to connect to mechanical vent
Airway protection & mechanical vent.
Temp.; 14-21 days
What are some complications of ORAL endotracheal intubation? (7)
Trauma to lips, gums, lips, tongue, pharynx, larynx
Vocal fold damage: direct, cuff overinflation
Hypoxemia: Lack of oxygen to tissues
Left lung collapse
Esophageal intubation (putting in wrong way, distension)
Rupture of esophagus
What are some complications of NASAL endotracheal intubation? (2)
Long-term complications? (7)
Otitis media and conductive hearing loss
Pressure necrosis (skin breakdown)
Granulomas (lumps forming into polyp)
Laryngeal web (membranous formation)
Glottic incompetence (protection)
Endotracheal tube cuffs
Tracheal stenosis (narrowing of trachea)
What is a tracheotomy?
What are indications (needs for trach)? (6)
Surgical placement of plastic or metal tube into trachea to create an airway
Reduced risk of laryngeal complications
Improved weaning from mech. vent.
Increased options for oral communication and feeding
Indications for tracheotomy cont. (9)--more serious
Paralysis of muscles affecting swallow causing danger of aspiration
Subglottic stenosis from prior trauma
Obstruction from obesity for sleep apnea
Congenital abnormality of larynx or trachea
Severe neck/mouth injuries
Inhalation of corrosive material smoke or steam
Presence of large foreign body that occludes airway
long term unconsciousness or coma
Procedure of trach
Incision at 2nd or 3rd tracheal ring
Tube size based on age, weight, height
Complications of ETT--Explain why
Related to abrasion at stoma site (58%)
Softening of cartilage of trachea due to erosion of tracheal rings
Narrowing that occurs with healing (infection, tube changes, tugging on tube, large stoma)
Necrosis of tracheal and esophageal wall which forms passageway between GI tract & airway
Materials of trach tubes?
PVC- single use
Silicone- sterilized and reused
PVC mixed with silicone
Parts of trach tube
outer and inner cannula
Flange (neck plate, holds tube in place)
Obturator (eases insertion)
Button (occludes tube used for weaning)
Cuff (prevent air escape)
Types of trach tubes--Explain them
Cuffed or cuffless, single or multiple fenestrations, allows air to pass from trachea through fenestrations to vf, improves phoantion, not used for those high risk of aspiration, use in decannulation
Attached to inflation line leading to pilot balloon, used during mech. vent., reduces risk of aspirated secretions entering trachea, fenestratrated/nonfenestrated, high volume, low pressure
Single-outer cannula only, provides least airway resistance
Double- Used with outer and inner--standard tube
Extra long- Single, special needs patients (stenosis, malacia, anatomy changes, burns)
Trach tube variations
Other trach tubes?
Size, tube angle, cuffs (high volume low pressure, shape, fit to tube), Flange (swivel, shape, material), inner cannula (texture, connection)
Talking trach tube--vent dependent, can't tolerate cuff deflation; external air tube connected to compressed air, provides continuous airflow for speech
Tracheal buttons- maintain open stoma after trach removal; maintains opening in trach wall
1-way valve allows air to enter trachea on inspiration, valve closes on expiration directing air upward through vf; phonation or cough/clear throat
Impact of trach on swallowing?
Complications inherent in population who may need trach
Reduced laryngeal excursion (horizontal incision, decreased BOT--pressure and disuse, weight of equipment, cuff inflation (drags tracheal wall over, partial esophageal obstruction, disruption of esophageal pressures due to changes in timely CP relaxation and opening)
Saliva and secretion management with trach/swallowing?
Medications specific to trach and ventilator dependent patients may lead to xerostomia
Increased secretions (upper airway filtering and humidification bypassed), chronic lung disease, lack of fluid intake (dehydration)
Physiologic impact on swallowing
Disruption of airway pressures resulting in pharyngeal residue (1-way valves normalized pressures for less impact)
Reduction of airflow through glottis (elimination of expiratory airflow to clear residue from airway, loss of laryngeal sensation, disco ordination of glottic closure response--w/in 3 months)
Effects of mech. vent. on swallowing
Disruption of normal apneic interval (vent may force air in when vf closure is occurring, disruptions swallow sequence)
Tube feedings/intubation (premorbid dysphagia patients more at risk, difficulty tolerating extubation due to decreased airway protection; feeding tubes increase aspiration risk; NPO increases potential for bacteria (ORAL CARE)
GI bleeding from stress ulcers (physical and emotional stress)
Oral feeding and cuff inflation
Aspiration: Cuff inflation does NOT prevent aspiration--incomplete seal, accumulation of aspirated material at top of cuff, destruction of cilia (remove mucus and aspirated contents, destroyed at cuff inflation site)