chapter 13 endotracheal tube and tracheostomy 13 endotracheal tube and tracheostomy care procedure...

Click here to load reader

Post on 21-Mar-2018

224 views

Category:

Documents

4 download

Embed Size (px)

TRANSCRIPT

  • Chapter 13 Endotracheal Tube and Tracheostomy Care

    Procedure 93 Assisting With Endotracheal Intubation

    Procedure 94 Ventilating An Endotracheal Tube Using A Bag-Valve Device

    Procedure 95 Ventilating A Tracheostomy Using A Bag-Valve Device

    Procedure 96 Suctioning A Tracheostomy

    Procedure 97 Giving Tracheostomy/Stoma Care Using A Nondisposable Inner Cannula

    Procedure 98 Giving Tracheostomy/Stoma Care Using A Disposable Inner Cannula

    Procedure 99 Applying A Tracheostomy Dressing And Ties

  • PERFORMANCE REVIEW CHECKLIST

    Procedure 93

    Assisting With Endotracheal Intubation

    Name of Patient Care Technician ________________________ Date of Program ______ to ______

    Social Security Number or Identification Number _______________________________

    Program Code Number (if any) _________________

    S=Satisfactory PerformanceU=Unsatisfactory Performance

    Place a full signature to correspond with each set of initials appearing below.

    Supplies needed:

    Disposable exam gloves Mask, face shield, or other personal protective equipment depending on the patient situa-

    tion and facility policy Sterile towel or drape Laryngoscope handle and blades Endotracheal tubes, assorted sizes; ask the licensed professional to select the proper size

    tube Stylette, a wire inserted through the tube to reduce flexibility Magill forceps (these will be used if a foreign body is present, or if nasotracheal intubation

    is necessary) 10-mL syringe Kelly clamp or other hemostat Water-soluble lubricant Suction, set up with flexible catheter Tape, 1- and 2-inch sizes, or endotracheal tube holder Tincture of benzoin solution Cotton applicators Oral airway Stethoscope Bag-valve-mask apparatus Humidified oxygen source Sterile gauze pads Sterile water Sterile basin

    Initials Corresponding Signature of Instructor Title

  • Procedure Guidelines S/U Date Initials S/U Date Initials

    1. Perform your beginning procedure actions.

    2. Set up the equipment for intubation. Place it in a convenient location on a sterile towel or other drape, close to the patients head.

    3. Check the light on the laryngoscope blade(s) to ensure that they are bright, white, and steady. Snap the blade onto the handle, then fold it up and down. When pulled up, the light should go on. Folding it down turns the light off.

    4. Open the sterile package containing the endotracheal tube. Leave the tube within the package, removing only the inflation port for the cuff. The tube must remain sterile.

    5. Pull the plunger back on the syringe. Attach it to the inflation port on the endotracheal tube. Slowly inject air into the inflation port to check the cuff for leaks. Pull back on the plunger to deflate the cuff.

    6. Lubricate the entire stylet, and place it on the table next to the endotracheal tube.

    7. Tear the tape and place it over the edge of the table, or other convenient location.

    8. Squeeze water-soluble lubricant onto a sterile gauze pad.

    9. Prepare the humidified oxygen.

    10. Set up the suction.

    11. Apply gloves and other personal protective equipment.

    12. Remove the patients dentures or partial plate. Store dentures in a labeled container of water in a safe location.

    13. Assist the licensed health care professional as directed while he or she performs the intubation procedure. You may be asked to ventilate the patient before the procedure.

  • __________________________________ _______________

    Instructor Signature Date

    __________________________________ _______________

    Student Signature Date

    14. After the tube has been inserted, note and record the centimeter mark on the tube where it exits the mouth. Record the volume of air used to inflate the cuff.

    15. After insertion, call x-ray for a portable x-ray for tube placement.

    16. Perform your procedure completion actions.

    Procedure Guidelines S/U Date Initials S/U Date Initials

  • PERFORMANCE REVIEW CHECKLIST

    Procedure 94

    Ventilating An Endotracheal Tube Using A Bag-Valve Device

    Name of Patient Care Technician ________________________ Date of Program ______ to ______

    Social Security Number or Identification Number _______________________________

    Program Code Number (if any) _________________

    S=Satisfactory PerformanceU=Unsatisfactory Performance

    Place a full signature to correspond with each set of initials appearing below.

    Supplies needed:

    Disposable exam gloves Eye protection and face mask Bag-valve-mask Oxygen source with nipple adapter for connecting tubing Oxygen connecting tubing

    Initials Corresponding Signature of Instructor Title

    Procedure Guidelines S/U Date Initials S/U Date Initials

    1. Perform your beginning procedure actions.

    2. Connect the bag-valve-mask device to the connecting tubing. Attach the connecting tubing to the oxygen flow meter.

    3. Turn the flow meter on to 15 liters per minute, or as instructed.

    4. If the bag-valve-mask is assembled, remove the mask by twisting and pulling slightly.

    5. Connect the bag-valve to the endotracheal tube.

  • __________________________________ _______________

    Instructor Signature Date

    __________________________________ _______________

    Student Signature Date

    6. Squeeze the bag with sufficient force to cause the patients chest to rise. Release the bag. Repeat at a rate of once every 3 to 5 seconds, or as directed. The rate may vary depending on the purpose of the procedure.

    7. Upon completion, disconnect the bag-valve device and reconnect the endotracheal tube to the ventilator, or as instructed.

    8. Perform your procedure completion actions.

    Procedure Guidelines S/U Date Initials S/U Date Initials

  • PERFORMANCE REVIEW CHECKLIST

    Procedure 95

    Ventilating A Tracheostomy Using A Bag-Valve Device

    Name of Patient Care Technician ________________________ Date of Program ______ to ______

    Social Security Number or Identification Number _______________________________

    Program Code Number (if any) _________________

    S=Satisfactory PerformanceU=Unsatisfactory Performance

    Place a full signature to correspond with each set of initials appearing below.

    Supplies needed:

    Disposable exam gloves Eye protection and face mask Bag-valve-mask device Oxygen source with nipple adapter for connecting tubing Oxygen connecting tubing

    Initials Corresponding Signature of Instructor Title

    Procedure Guidelines S/U Date Initials S/U Date Initials

    1. Perform your beginning procedure actions.

    2. Connect the bag-valve-mask device to the connecting tubing. Attach the connecting tubing to the oxygen flow meter.

    3. Turn the flow meter on to 15 liters per minute, or as instructed.

    4. If the bag-valve-mask is assembled, remove the mask by twisting and pulling slightly.

    5. Connect the bag-valve to the adapter on the inner cannula.

  • __________________________________ _______________

    Instructor Signature Date

    __________________________________ _______________

    Student Signature Date

    6. Squeeze the bag with sufficient force to cause the patients chest to rise. Release the bag. Repeat at a rate of once every 3 to 5 seconds, or as directed. The rate may vary depending on the purpose of the procedure.

    7. Upon completion, disconnect the bag-valve device and reconnect the cannula to the ventilator, or as instructed.

    8. Perform your procedure completion actions.

    Procedure Guidelines S/U Date Initials S/U Date Initials

  • PERFORMANCE REVIEW CHECKLIST

    Procedure 96

    Suctioning A Tracheostomy

    Name of Patient Care Technician ________________________ Date of Program ______ to ______

    Social Security Number or Identification Number _______________________________

    Program Code Number (if any) _________________

    S=Satisfactory PerformanceU=Unsatisfactory Performance

    Place a full signature to correspond with each set of initials appearing below.

    Supplies needed:

    Sterile gloves Eye protection Surgical mask Gown Sterile towel, according to facility policy Sterile drape to set up sterile field Sterile suction catheter Sterile normal saline Sterile basin Sterile, lint-free sponges Alcohol sponge Bag-valve-mask device Plastic bag for used supplies

    Initials Corresponding Signature of Instructor Title

    Procedure Guidelines S/U Date Initials S/U Date Initials

    1. Perform your beginning procedure actions.

    2. Prepare the sterile field, if you have not done so previously. Pour sterile normal saline into the sterile basin.

    3. If the bag-valve-mask device is assembled, remove the mask by twisting and pulling slightly.

  • 4. Connect the bag-valve to the tracheostomy and firmly ventilate the patient 4 or 5 times. Synchronize your ventilations with the patients respirations. Avoid squeezing the bag while the patient is exhaling.

    5. Apply sterile gloves.

    6. Drape the sterile towel across the patients upper chest.

    7. Attach the suction catheter to the connecting tubing. The hand that touches the connecting tubing is no longer sterile.

    8. Turn the suction on with the nonsterile hand.

    9. Holding the catheter with your sterile hand, insert the tip into the saline. Suction a small amount of saline through the catheter to lubricate the inside. Secretions will flow through the catheter more readily if the inside is lubricated first.

    10. Gently insert the suction catheter into the inner cannula until you meet resistance (approximately 6 inches), then withdraw 2 to 3 cm. If the patient begins to cough, do not insert the catheter further. Withdraw

View more