Tracheostomy - A Multiprofessional Handbook, Claudia Russell, Basil Matta

INDEX sternomental distance 73 superior laryngeal nerve 9 stoma supine position 26, 120–121 supplies, community 296–297, 332 assessment 174 support groups 302, 329–330 care see wound care surfactant 14–16, 147–148 cleaning 176 surgical tracheostomy, standard (SST) closure after decannulation 66–67, 35–58 183–185, 264 complications 51–57 radiation dose 278 elective 37 see also wound indications 35–37 stoma protectors 153 operative procedure 38–50 strap muscles 43 paediatric patients 47, 311–312 Streptococcus pneumoniae 345, 347 pre-operative care and assessment Streptococcus pyogenes (␤ haemolytic 37–38 Streptococcus; Group A) 349 vs PDT 60–61 Streptococcus viridans 345 sutures stress, psychological 126 securing tracheostomy tube 49, 50, 174 stress relaxation 16 stay/traction 47–48, 244, 311–312, 320 stretch receptors, pulmonary 3 wound closure 49, 174 stylets, lighted intubating 80–81 swallowing 187–208 subcutaneous tissues, radiation effects assessment 196–203, 207–208 279–280 blue dye test see blue dye test subglottic air pressure 195, 217 complementary methods 202–203 subglottic cysts 310 before decannulation 257–258 subglottic stenosis 310 cranial nerves involved 188 suction catheters difficulties see dysphagia impact of tracheostomy tube 31, 56, 91, disposal 162 insertion 162 191–195 paediatric 322 mechanical ventilation and 195–196 selection 159–160, 161 normal 188–190 suction ports, tracheostomy tube cuffs quality of life aspects 204 relationship to respiration 191 with 95, 96 Swedish nose 151–152 suction units swimming 298 synchronised intermittent mandatory closed system multiple use (CSMU) 167–168 ventilation (SIMV) 133, 134 home 297, 303 talking tubes, cuffed 96, 97 portable 159, 160, 297 tapes, tracheostomy 49–50, 51, 180–181 wall 159 Suctionaid 95, 96 changing 180 suctioning 55, 157–171 paediatric patients 323–324 after decannulation 262 taste, loss of sense of 195 assessment prior to 158–159 teeth 213 complications 163–165 Tegaderm 184 equipment 159–160 telephone contacts 303 fenestrated tubes 101, 165 teletherapy 270 indications 158 temperature, air 143–144, 145, 298 infection control 160–161, 165, 355–356 temporal mandibular joint mobility 72 paediatric patients 321–322, 341 thyroarytenoid muscle 10, 11 preparation for 160–161 technique 162–167 389

TRACHEOSTOMY: A MULTIPROFESSIONAL HANDBOOK thyrohyoid membrane 8 components 86–88 thyroid cartilage 8, 10 cuff see cuff, tracheostomy tube thyroid isthmus 43, 44–46, 52 cuffed see cuffed tracheostomy tubes thyromental distance 73 disconnection 129, 130 tidal volume 19 displacement 54, 129, 130 tight to shaft (TTS) tracheostomy tubes 95 time constant 27 flowchart 252 tongue 189, 213 double lumen 102–103, 110, 124 total lung capacity 20 trachea 11 changing 243–244 see also inner cannula necrosis 55–56, 66, 164 extra long 100, 101, 102, 112 stenosis see laryngotracheal stenosis fenestrated see fenestrated tracheostomy surgical incision 46, 48 surgical injury 53 tubes ulceration 128, 129, 164 flange/neck plate 87–88 tracheal bib 153 home supplies 297 tracheal dilators indications and contraindications 100 changing tracheostomy tubes 248–250 inner cannula see inner cannula PDT 63, 64 insertion 48, 63–64 surgical tracheostomy 40, 41, 48, 49 introducer/obturator 88 tracheal ring fractures 66 length 107 tracheal suctioning see suctioning manipulation, in dysphagia 203–204 tracheitis 55 materials 104–105 tracheo-arterial fistula 56 misplacement tracheobronchial tree 11–13 tracheocutaneous fistula 57, 66–67 flowchart 252 Tracheofix 94 in one bronchus 129, 130 Tracheoflex armoured tube 106 paratracheal/pre-tracheal 65–66, 129, tracheomalacia 66, 215, 300 tracheo-oesophageal fistula 53, 56, 57, 261 130, 312 tracheostomy 29–34 signs 247 benefits see benefits of tracheostomy during tube changes 246–247 drawbacks 30–31, 119 neonatal 99, 103–104, 114 history 29–30 obstruction 130–131, 312 indications see indications for by herniated cuff 129, 131 by kinks 129, 131 tracheostomy management 169 nomenclature 29 by secretions/encrustment 55, 129, physiological effects 22, 30–31, 130–131 122–123, 157 occlusion tracheostomy tubes 38–40, 85–114 before decannulation 257, 262 15 mm adaptor 88 in swallowing assessment 197, 198 accessories 89–90 in voice quality assessment 220–221 adjustable flange 87, 88, 101 in weaning process 260, 261 adult ranges 110–112 occlusion cap 89–90, 260 care and maintenance 356 outer cannula 86 changing see changes, tracheostomy tube paediatric see under paediatric patients checking 126, 239 pilot balloon 87 communication and 214–217 during radiotherapy 277–278 complications 106–109 removal see decannulation securing 49–50, 64, 180–181 in children 300 selection 90–91, 106–109, 124–125 390

INDEX single lumen (adult) 102, 111 Valsalva manoeuvre 23, 24 changing 244 Velcro tube holders 178, 180–181, 300 ventilation 25–28 size 106–107, 124 growing child 300 distribution 26–27 reducing, to enable speech 222–223 in ICU patients 120, 121 for weaning 258 ventilated patients 122 swallowing and 31, 56, 91, 191–195 mechanical see mechanical ventilation types 91–104 ventilation/perfusion matching 25–26 uncuffed 96–97, 98, 111 width 106, 108, 124 in ICU patients 121 tracheotomy 29 ventilation/perfusion (V/Q) ratios 27–28 Trachi-dress 179 ventilator Trachlight (lighted stylet) 80–81 Tracoe comfort tubes 98 modes, used in weaning 133–134 Tracoe XLT tubes 100, 101 tracheostomy tube disconnection 129, training carers 289 130 children 326–327 tubing, avoiding traction from 174 child’s parents/carers 245, 301, 326 ventilatory rate 27 communication partners 232 ventilatory support, assessment 126 infection control 355 verbal communication 219–227 transitional flow 18, 19 assessment for 220–221 translaryngeal tubes see endotracheal (ET) contraindications 220 indications 219 tubes maximising airflow into upper airway transpulmonary pressure 21 transtracheal needle ventilation 32 222–223 transverse arytenoid muscle 10 speaking valves see speaking valves trauma 35, 36 see also voice production Travis self-retaining forceps 40, 42, 43–44 vestibulocochlear (VIII) nerve 212 trigeminal nerve (V) 9, 188, 212 videofluoroscopy 202 trochlear nerve 212 vincristine 271 tuberculosis (Mycobacterium tuberculosis) viral infections 350–351 vital capacity 20 343, 350 vocal cords 8–9, 10 tubes, tracheostomy see tracheostomy tubes airway protection 191, 213 turbulent flow 17, 18 damage preventing decannulation upper airway 263 airflow, maximising 222–223 endotracheal intubation-induced injury anatomy 7–9 heat and moisture exchange 143–145 214–215 innervation 9 function, assessment 198 patency, assessment 197, 220–221 paralysis 35, 215, 310 reflexes 3–4 in swallowing 190 in voice production 212–213 upper airway obstruction 35–36, 118 Vocalaid Portex 96, 97 paediatric patients 309, 310 vocalis muscle 11 partial, assessment 53–54 voice production assessment 220–221 vagus nerve (X) 9, 53, 188, 212 lost or reduced 215–217 stimulation 128 normal 212–213 ventilated patients 217–218 see also verbal communication vomiting 369 391

TRACHEOSTOMY: A MULTIPROFESSIONAL HANDBOOK waste disposal 353–354 work of breathing 6 water (moisture) assessment, in ICU patients 126 effects of tracheostomy 123 in air 143–144, 145, 146–147 protecting stoma from 297, 315 wound weaning assessment 174 mechanical ventilation 37 closure 49, 54 dressings see dressings, wound definitions 132 packing 48 ICU patients 123, 132–137 see also stoma modes of ventilation used 133–134 protocol directed 134–135 wound care 173–186 role of physiotherapy 138 after decannulation 183–185, 264–265 role of speaking valve 135–137, 138 in head and neck cancer 281 tracheostomy 260–262 hypergranulation 181–183 chart 259–260, 266–268 immediate post-operative 173–174 indications 257 paediatric patients 323 multidisciplinary management 256 peri-stoma skin 175–176 problems/troubleshooting 262–263 tube type and size for 258–259 wound infections 55, 65, 175, 181, 355 see also decannulation writing 229 weight, body 362–363 Wilson risk scoring system 73 XLT tubes 100, 101 Yang’s Rapid Shallow Breathing Index 133 392