tracheostomy emergencies and resuscitation

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1 Tracheostomy Tracheostomy Emergencies Emergencies & Resuscitation & Resuscitation Joy Norton Joy Norton Tracheostomy Tracheostomy safety safety facilitator SJH facilitator SJH Must know the reason why your Must know the reason why your pateint pateint has has tracheostomy tracheostomy tube! tube! The purpose of a The purpose of a tracheostomy tracheostomy tube tube is to maintain a patent airway and is to maintain a patent airway and permit the removal of permit the removal of bronchotracheal bronchotracheal secretions. secretions. When caring for a patient with a When caring for a patient with a tracheostomy tracheostomy it is vital that staff are it is vital that staff are aware of: aware of: 1. 1. Why the Why the tracheostomy tracheostomy was was performed in the first instance. performed in the first instance. 2. 2. Whether the upper airway is patent, Whether the upper airway is patent, partially or completely obstructed partially or completely obstructed 3. 3. How long the How long the tracheostomy tracheostomy has has been established. been established. Know your tube type Know your tube type Staff looking after a patient with a Staff looking after a patient with a tracheostomy tracheostomy must also know what must also know what type of type of Tracheostomy Tracheostomy tube is in situ tube is in situ Shiley/Portex Shiley/Portex Cuffed Cuffed – fenestrated/non fenestrated fenestrated/non fenestrated Non Cuffed Non Cuffed – fenestrated/non fenestrated/non fenestrated fenestrated XLT XLT – extended length extended length – why?? why?? Emergency Bedside Equipment: Emergency Bedside Equipment: Appropriate SJH Appropriate SJH Tracheostomy Tracheostomy Tray Tray Contains necessary emergency Contains necessary emergency equipment equipment Functioning Suction Functioning Suction Functioning Oxygen Functioning Oxygen Spare inner Spare inner cannula cannula Check your equipment every Check your equipment every shift shift Common Emergencies Common Emergencies associated with associated with Tracheostomy Tracheostomy patients: patients: Accidental Accidental decannulation decannulation – tube tube falls out falls out Tube Occlusion Partial/Complete Tube Occlusion Partial/Complete Respiratory/Cardiac Arrest Respiratory/Cardiac Arrest Accidental Accidental Decannulation Decannulation – Tube falls out Tube falls out

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Tracheostomy Emergencies and Resuscitation guide

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Page 1: Tracheostomy Emergencies and Resuscitation

1

TracheostomyTracheostomy Emergencies Emergencies & Resuscitation& Resuscitation

Joy Norton Joy Norton TracheostomyTracheostomy safety safety facilitator SJHfacilitator SJH

Must know the reason why your Must know the reason why your pateintpateint has has tracheostomytracheostomy tube!tube!

�� The purpose of a The purpose of a tracheostomytracheostomy tube tube is to maintain a patent airway and is to maintain a patent airway and permit the removal of permit the removal of bronchotrachealbronchotracheal secretions.secretions.

�� When caring for a patient with a When caring for a patient with a tracheostomytracheostomy it is vital that staff are it is vital that staff are aware of:aware of:

1.1. Why the Why the tracheostomytracheostomy was was performed in the first instance.performed in the first instance.

2.2. Whether the upper airway is patent, Whether the upper airway is patent, partially or completely obstructedpartially or completely obstructed

3.3. How long the How long the tracheostomytracheostomy has has been established.been established.

Know your tube typeKnow your tube type

�� Staff looking after a patient with a Staff looking after a patient with a tracheostomytracheostomy must also know what must also know what type of type of TracheostomyTracheostomy tube is in situ tube is in situ ––

�� Shiley/PortexShiley/Portex�� Cuffed Cuffed –– fenestrated/non fenestratedfenestrated/non fenestrated�� Non Cuffed Non Cuffed –– fenestrated/non fenestrated/non

fenestratedfenestrated�� XLT XLT –– extended length extended length –– why??why??

Emergency Bedside Equipment:Emergency Bedside Equipment:

�� Appropriate SJH Appropriate SJH TracheostomyTracheostomy TrayTray�� Contains necessary emergency Contains necessary emergency

equipmentequipment�� Functioning SuctionFunctioning Suction�� Functioning OxygenFunctioning Oxygen�� Spare inner Spare inner cannulacannula

Check your equipment every Check your equipment every shiftshift

Common Emergencies Common Emergencies associated with associated with TracheostomyTracheostomypatients:patients:

�� Accidental Accidental decannulationdecannulation –– tube tube falls out falls out

�� Tube Occlusion Partial/CompleteTube Occlusion Partial/Complete

�� Respiratory/Cardiac ArrestRespiratory/Cardiac Arrest

Accidental Accidental DecannulationDecannulation ––Tube falls outTube falls out

Page 2: Tracheostomy Emergencies and Resuscitation

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•• *If *If tracheostomytracheostomy tube becomes tube becomes dislodged dislodged DONDON’’T PANICT PANIC..

•• Once tube Once tube insituinsitu more than one more than one week the tract is usually well formed week the tract is usually well formed and will not close over straight away.and will not close over straight away.

•• *If tube *If tube insituinsitu less than 10 days a less than 10 days a stay suture should be taped to stay suture should be taped to patients chest. By pulling on this patients chest. By pulling on this suture the trachea is brought forward suture the trachea is brought forward and airway usually opened to and airway usually opened to facilitate tube replacementfacilitate tube replacement

Call for helpCall for help.. Inform ward staff to Inform ward staff to inform appropriate person: inform appropriate person:

•• Anaesthetist on call Anaesthetist on call #889 #889 onon site site 24/724/7

•• MonMon--Fri 07.30Fri 07.30--16.00 16.00 TracheostomyTracheostomynursenurse #538#538

•• Staff St Johns ward for Staff St Johns ward for support/advice support/advice ext 2181. ext 2181.

•• ENT/Max Fax ENT/Max Fax RegReg on call on call VIA VIA SWITCH BOARD. SWITCH BOARD.

•• While waiting for help to arrive. While waiting for help to arrive. •• Reassure the patient, andReassure the patient, and

reinsert new reinsert new tracheostomytracheostomy tube if tube if competent to do so.competent to do so.

•• Open Open trachytrachy emergency tray at emergency tray at bedside, take out bedside, take out trachytrachy dilator.dilator.

•• Keep stoma open by gently Keep stoma open by gently inserting inserting dilatatordilatator. Ensure . Ensure correct position metal parts correct position metal parts should be north and south.should be north and south.

�� If patient If patient desaturatesdesaturatesadminister O2 via stoma. If administer O2 via stoma. If stoma appears to have closed stoma appears to have closed over try via face mask.over try via face mask.

� Have trachy tube same size and a size smaller ready for the person to insert the new tube.(use cotton ties to secure tube if patient confused)

� Have patient reviewed by medical person after event.

� Complete risk occurrence form

Tube occlusion: Partial/CompleteTube occlusion: Partial/Complete�� Assess the patient.Assess the patient.�� Check inner Check inner cannulacannula..�� Call for help.Call for help.�� Administer oxygen and monitor SpO2.Administer oxygen and monitor SpO2.�� Suction Suction patient.(ifpatient.(if resistance noted)resistance noted)�� Deflate cuff if patient has cuffed tube.Deflate cuff if patient has cuffed tube.�� Check for air flow from Check for air flow from trachytrachy using your arm.using your arm.�� If If tracheostomytracheostomy tube remains occluded remove tube remains occluded remove

it it –– except in ICU setting, apply except in ICU setting, apply ambuambu bag and bag and await anaesthetic assistance.await anaesthetic assistance.

�� Reinsert new Reinsert new tracheostomytracheostomy tube if competent to tube if competent to do so.do so.

�� If not If not –– keep stoma open using tracheal dilatorkeep stoma open using tracheal dilator�� Administer oxygen and reassure patient until Administer oxygen and reassure patient until

help arrives.help arrives.

RepiratoryRepiratory/Cardiac Arrest /Cardiac Arrest Situation:Situation:

�� Call for helpCall for help�� Basic Life Support Basic Life Support –– Circulation, Airway, Circulation, Airway,

Breathing (30 compressions to 2 breaths)Breathing (30 compressions to 2 breaths)�� Lie patient flat and remove any clothing Lie patient flat and remove any clothing

from the neck from the neck –– check patency of the inner check patency of the inner cannluacannlua

�� Assess breathingAssess breathing�� Has the patient a cuffed tube Has the patient a cuffed tube insituinsitu??

�� Yes Yes –– ensure cuff is inflated (5ensure cuff is inflated (5--7mls air)7mls air)�� No No –– change to cuffed tube it competent to change to cuffed tube it competent to

do so.do so.

Maximum ventilation and oxygenation Maximum ventilation and oxygenation occurs when there is a cuffed, non occurs when there is a cuffed, non fenestrated fenestrated tracheostomytracheostomy tube tube insituinsitu

Page 3: Tracheostomy Emergencies and Resuscitation

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�� Give two breaths via Give two breaths via tracheostomytracheostomy tube tube ––attach catheter mount to the top of the attach catheter mount to the top of the tracheostomytracheostomy tube (ideally cuffed), attach tube (ideally cuffed), attach the Bag Valve Mask (BVM) to 15L of the Bag Valve Mask (BVM) to 15L of oxygen. Remove face from BVM and oxygen. Remove face from BVM and attach to catheter mount.attach to catheter mount.

�� Make sure you see the patients chest riseMake sure you see the patients chest rise

LaryngectomyLaryngectomy Patient:Patient:

�� LaryngectomyLaryngectomy patients can not be patients can not be intubatedintubated orally or nasallyorally or nasally

�� Same steps as before Same steps as before –– Basic Life Basic Life SupportSupport

�� Mouth to stoma breathing/paediatric Mouth to stoma breathing/paediatric face maskface mask

�� Insert cuffed, non fenestrated Insert cuffed, non fenestrated tracheostomytracheostomy tubetube

Who Do I call For Help?!!Who Do I call For Help?!!

�� Emergency number Emergency number –– 2222 (SJH)2222 (SJH)�� Staff on your wardStaff on your ward�� ENT/Max Fax TeamENT/Max Fax Team�� TracheostomyTracheostomy Safety Facilitator Safety Facilitator --

#538#538�� Anaesthetist on call Anaesthetist on call –– #889 (SJH)#889 (SJH)

Over bed sign for Over bed sign for tracheostomytracheostomy patientpatient

Over bed sign for Over bed sign for laryngectomylaryngectomy patientpatient

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Page 4: Tracheostomy Emergencies and Resuscitation

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Discharge needsDischarge needs��Early discharge Early discharge

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�� Ensure patient and their families prepared Ensure patient and their families prepared should tube become dislodged.. .How?should tube become dislodged.. .How?

�� Action plan: know exact location in house Action plan: know exact location in house where spare where spare tracheostomytracheostomy tube kept. tube kept. ResiteResite immediately if patient/family immediately if patient/family member competent to do so. Must always member competent to do so. Must always be reviewed by medical person following be reviewed by medical person following event.event.

�� If patient /family member not competent to If patient /family member not competent to replace tube, patient must bring spare tube replace tube, patient must bring spare tube with them to their nearest A&Ewith them to their nearest A&E

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