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Judith Moore-Hepburn
RN, BScN, MScN, ET
Goals
Detrimental Effects:
• Oxygen induced hypoventilation
• Absorption atelectasis
• Oxygen toxicity
Hypoxic Breathing Stimulus
• Normally body is stimulated to breathe because of
buildup of CO2 which stimulates the respiratory centre
• Usually reversible
Nasal Prongs
1 Lpm 21-24%
2 Lpm 24-28%
3 Lpm 28-32%
4 Lpm 32-36%
5 Lpm 36-40%
6 lLpm 40-44%
4 Lpm 24%
5 Lpm 28%
6 Lpm 31%
7 Lpm 35%
8 Lpm 40%
10 Lpm 50%
Steps:
1. Attach the open end of the clear tubing to the port or
opening at the bottom of the incentive spirometer. The
mouthpiece is at the other end of the tubing.
6. When you feel you cannot breath in any longer take the
mouthpiece out of your mouth. Hold your breath for 3-5 seconds
then breath out slowly.
How to Use an Incentive Spirometer
7. Breathe normally for a few breaths and let the piston return to
the bottom of the chamber.
8. Set the goal indicator tab at the level that you reached.
9. Repeat the slow, deep breath in and slow breath out again.
Continue this cycle for a total of 15 breaths. If you start to feel
lightheaded or dizzy, slow your breathing down and take a longer
time with normal size breaths between the deep breaths
Tracheostomy
• Surgical creation of a stoma into the trachea
• Emergency or Elective
Why Is it Done?
• Relief of acute or chronic upper airway obstruction
• Access for continuous mechanical ventilation
• Prevention of aspiration pneumonia
• Prolonged endotracheal tube insertion resulting in
erosion or pain
Tracheostomy
• Tracheostomy is fitted with a tube to maintain airway patency
• Tubes vary in size, shape and number of parts
Permanent Tracheostomy:
• Often with laryngectomy patients the trachea is
sutured to the skin so they do not need tube
once the stoma is healed
Potential Problems
Associated with a Tracheostomy
Tracheal Wall Necrosis:
• Can lead to the formation of a fistula with the esophagus
• Abdominal distension because air escapes into the stomach
• Can also lead to life threatening hemorrhage if erosion goes into
the artery; you may detect pulsation in the tracheostomy tube
before erosion takes place
• Associated with extended use of cuffed trach and or a trach cuff
that has been over inflated
Tracheal Dilation:
• Suspect when it takes increasing amounts of air to seal the cuff
Potential Problems
Associated with a Tracheostomy
Tracheal Stenosis:
• Narrowing of the trachea resulting from the formation of scar
tissue
• Prevented by choosing right size of tube, maintaining proper cuff
inflation
Airway Obstruction:
• Occlusion of trachea for several reasons, most common is the
accumulation of dried secretions
• First step is to remove the inner cannula, if it does not clear,
suction, & inject 3-5 mL normal saline into trach if you need to
loosen secretions
• Long term: ensure adequate hydration to promote thinner
secretions
Potential Problems
Associated with a Tracheostomy
Infection:
• Increased risk b/c bypass the upper airway protective mechanisms,
decreased mucociliary action and often a diminished cough
• Can also get a stoma infection
• Protocol for complete changes of the tracheostomy tube, maximum
time b/t changes should not exceed 6-8 weeks
Accidental Decannulation:
• To reinsert remove the inner cannula, deflate the cuff, place the
obturator into the out cannula, insert into the stoma and
immediately remove the obturator
• Call for help
Weaning from a Tracheostomy:
• Begins by deflating the cuff to determine the client’s ability to
manage secretions without aspirating them
• May insert a smaller uncuffed tube to ensure adequate ventilation
around the tube
• The tube is then plugged to determine the client’s ability to breath
through the upper airway, start with short time and lengthen as ct is
able to tolerate
• Weaning can take 2-5 days