Question

12. Why might a stylette be used when intubating a patient? 13. How does one know that the endotube is in the trachea following intubation? 14. Why are there two inner cannulas with a fenestrated trach tube? What implications are there for using a suction catheter? 15. What things can be done to prevent infection at the tracheostomy site? 16. List two precautions when using a speaking valve with a tracheostomy tube?

Answer 1

Ans) 12) Stylets are used inside an endotracheal tube to give it a certain shape which aids navigation of the tube towards the laryngeal inlet.

13) Use an end-tidal carbon dioxide detector (i.e., continuous waveform capnography, colorimetric and non-waveform capnography) to evaluate and confirm endotracheal tube position in patients who have adequate tissue perfusion.

14) The inner cannula fits inside the outer cannula. It has a lock to keep it from being coughed out, and it is removed for cleaning. The obturator is used to insert a tracheostomy tube. It fits inside the tube to provide a smooth surface that guides the tracheostomy tube when it is being inserted.

- Patients on mechanical ventilation and intubated patients are at risk of increased secretions as they are sedated, supine, and have mechanical adjuncts that prevent spontaneous clearance of secretions. Suctioning can help maintain and establish the gas exchange, adequate oxygenation, and alveolar ventilation.

15) Preventing infection at the tracheostomy site:

- Wash your hands:
Always wash your hands before and after any tracheostomy tube care.

- Clean tracheostomy equipment:
Clean the equipment the way your medical supply company shows you.

- Keep your neck clean and dry:
Change the gauze and tracheostomy ties when they are wet or dirty.

- Keep your mouth clean:
Saliva and secretions have germs that cause infection if they get into your airway. Brush your teeth at least 2 times a day.

- Clean your home equipment:
Your medical supply company will teach you how to clean your equipment.

- Keep hands clean:
Each person that comes into your home should wash their hands.

- Taking care of your skin around the tracheostomy:
Keep the skin around your stoma (neck opening) clean and dry. This will help prevent irritation and infection caused by secretions.

Skin should not have:
Sores
Redness
Drainage
Odor
Clean your skin around the stoma with soap and water at least 2 times a day. Clean more often if there is drainage.

- Supplies you will need:
Cotton-tipped applicator or washcloth
Liquid soap
Clean tap water

Steps to clean around your tracheostomy:
• Get the cotton-tipped applicator or washcloth wet with soapy tap water.
• Clean the stoma and exposed outer cannula using a rolling motion to remove any drainage from the skin and outer cannula.
• Rinse the stoma and exposed outer cannula with a wet cotton-tipped applicator or wet washcloth.
• Dry the skin and exposed outer cannula with a dry cotton-tipped applicator or dry washcloth.
• Place gauze under the ties next to the skin if you would like. Be sure to hold the tracheostomy tube while changing the gauze.

• Change the gauze if it becomes damp or dirty.