Endotracheal-and-Tracheostomy-Suctioning

Flashcards covering comprehensive guidelines and clinical considerations for endotracheal and tracheostomy suctioning, including types of tubes, laryngectomy anatomy, indications, safety measures, and specific techniques for different devices.

What is a defining feature of a Single Lumen Tracheostomy?

Features a single-chamber design with direct airway access.

When are Single Lumen Tracheostomies commonly used?

In emergency situations or when frequent cleaning is not required.

What distinguishes a Double Lumen Tracheostomy?

Contains both outer and inner cannulas.

What is an advantage of a Double Lumen Tracheostomy regarding maintenance?

Allows for easier maintenance and cleaning without tube removal, as the inner cannula can be removed for cleaning while maintaining airway patency.

What anatomical configuration exists after a partial laryngectomy?

Upper airway connection remains intact between the trachea and larynx, creating a dual pathway system.

In a partial laryngectomy, where can air flow?

Through both the natural upper airway and the tracheostomy opening.

What is maintained regarding upper airway patency in a partial laryngectomy?

Upper airway patency is maintained.

How is the trachea connected in a partial laryngectomy?

The trachea remains connected to the larynx.

What does the tracheostomy provide in a partial laryngectomy?

Secondary airway access.

What function might a patient with a partial laryngectomy retain?

Some vocal cord function.

What is a key consideration during positive pressure ventilation for a partial laryngectomy patient?

Air leakage is possible.

What anatomical alteration occurs in a complete laryngectomy?

The upper airway is permanently disconnected from the tracheal system.

What serves as the sole respiratory opening after a complete laryngectomy?

The tracheostomy.

Is air exchange possible through the nose or mouth after a complete laryngectomy?

No, there is no air exchange through the nose or mouth.

What is the rule for all airway management after a complete laryngectomy?

All airway management must occur through the tracheostomy.

Why are oral/nasal interventions not beneficial for respiratory support in complete laryngectomy patients?

They provide no respiratory benefit because the upper airway is completely separated from the trachea.

What patient criteria indicate the need for suctioning?

Patient with endotracheal or tracheostomy tube requiring airway clearance.

What clinical signs indicate the need for suctioning?

Airway obstruction or increased secretions compromising ventilation.

Why do tracheostomy patients face challenges in cold environments?

The natural warming and humidification mechanisms of the upper respiratory tract are bypassed.

What is lost for tracheostomy patients in cold environments?

Natural air warming capability through nasal passages.

What happens to tracheal tissues in cold outdoor environments for tracheostomy patients?

Direct exposure to cold atmospheric air.

What is required for tracheostomy patients when outdoors in cool weather?

Protective covering.

What materials are recommended for protective covering for tracheostomy patients outdoors?

Gauze or breathable fabric materials.

Why can occlusive dressings NOT be used for tracheostomy patients with complete laryngectomy?

They will completely obstruct the breathing pathway.

What is the first step for tracheostomy tube reinsertion according to the decision tree?

Have the patient raise their chin.

What instruction should be given to the patient during tracheostomy tube reinsertion?

Instruct the patient to inhale.

How should the tracheostomy tube be inserted during reinsertion?

Insert the tube much like an adult OPA.

What are the final steps after inserting a tracheostomy tube during reinsertion?

Seat, secure, and inflate.

What is the first step for tracheostomy suctioning according to the decision tree?

Insert catheter until a cough is stimulated.

After inserting the catheter, what is the next step for tracheostomy suctioning?

Withdraw catheter 0.5 cm.

What is the maximum duration and frequency for tracheostomy suctioning?

Suction for 10 seconds, every 1 minute as needed (PRN).

What technique should be used while withdrawing the catheter during suctioning?

Twist the catheter during withdrawal.

How can an NRB mask be applied for oxygen therapy via tracheostomy?

Apply an NRB mask over the tracheostomy.

How can PPV be delivered with an infant mask for oxygen therapy via tracheostomy?

PPV with an infant mask over the tracheostomy.

How can PPV be delivered directly to the tracheostomy tube for oxygen therapy?

PPV directly onto the tracheostomy tube adapter.

What is necessary for a partial laryngectomy patient when providing PPV with a BVM on the face?

It will be necessary to cover the tracheostomy.

What is the purpose of Medical Directive 01 for suctioning?

Establishes comprehensive guidelines for Advanced Care Paramedics (ACPs) and Primary Care Paramedics (PCPs) performing airway suctioning procedures.

What are the primary indications for suctioning according to Medical Directive 02?

Patient with endotracheal or tracheostomy tube experiencing airway obstruction or increased secretions requiring immediate intervention.

Does Medical Directive 03 impose age restrictions for suctioning?

No specific age restrictions.

What safety requirement is mandatory for suctioning procedures according to Medical Directive 04?

Mandatory aerosolization PPE for all personnel.

What is the recommended suction pressure for patients less than 1 year old?

60-100 mmHg.

What is the maximum suction duration for patients less than 1 year old?

10 seconds.

What is the recommended interval between suction attempts for patients less than 1 year old?

1 minute.

What is the recommended suction pressure for patients 1 year to less than 12 years old?

100-120 mmHg.

What is the recommended suction pressure for patients 12 years and older?

100-150 mmHg.

What is the maximum suction duration for patients 1 year and older?

10 seconds.

What is the recommended interval between suction attempts for patients 1 year and older?

1 minute.

What is the 'Pre-oxygenation Protocol' before suctioning?

Pre-oxygenate with 100% oxygen to optimize oxygen levels and prevent hypoxemia.

What is the recommended duration for pre-oxygenation prior to each suctioning attempt?

30-60 seconds.

What is encouraged in alert patients before mechanical suctioning?

Voluntary coughing to help clear the airway.

What can be more effective than mechanical suctioning for loose secretions in alert patients?

Voluntary coughing.

What is the first step for patient consent and preparation before ETT suctioning?

Explain the procedure and obtain consent from conscious patients, with implied consent for unconscious patients.

What is the 'Procedure Initiation Cross-Check (PICC)' for ETT suctioning?

Complete standardized verification process to ensure all safety measures are in place.

What is the optimal patient positioning for ETT suctioning when possible?

Sitting or semi-sitting position to optimize airway access and facilitate secretion drainage.

What catheter size should be chosen for ETT suctioning?

No larger than ½ the inner diameter of the endotracheal tube.

How should the suction catheter be lubricated if available?

With water or saline.

How should the suction catheter be inserted for ETT suctioning?

Without activating suction until cough reflex is stimulated or resistance is felt.

When should suctioning begin during ETT suctioning?

Withdraw catheter 0.5 cm, then begin suctioning while gently twisting and withdrawing.

What is the maximum total suctioning time for ETT suctioning?

Must not exceed 10 seconds.

How is the suction catheter cleared between attempts?

By drawing up saline or sterile water through the catheter.

For how long should a patient be re-oxygenated between ETT suction attempts?

For an entire minute.

What is a key advantage of closed circuit inline suction catheters?

Maintained ventilation during suctioning.

List two other advantages of closed circuit inline suction catheters.

Reduced risk of hypoxemia and lower infection control risk.

What should be checked if SpO₂ decreases post-inline suctioning?

Ensure the suction catheter is fully retracted in the T-piece and not obstructing ventilation airflow.

What two channels are incorporated into the I-Gel design?

The primary airway channel for ventilation and oxygenation, and the secondary gastric channel for decompression and secretion management.

What is the scope of practice limitation for PCP or ACP regarding SGA gastric port suctioning?

This procedure is NOT gastric decompression, but specifically addresses gastric secretions impacting SGA seal integrity.

What is a specific indication for SGA gastric port suctioning?

When gastric secretions around the SGA opening prevent proper seal formation after all other interventions have failed.

When should gastric port suctioning be considered a last-resort intervention?

When mechanical airway issues have been ruled out and gastric content is clearly compromising device function.

When should gastric port suctioning be stopped?

Turn off suction when fluid clears completely or if no fluid appears after 15 seconds of continuous suctioning.

What does the 'D' in DOPES stand for?

Displacement Assessment.

What does the 'O' in DOPES stand for?

Obstruction Assessment.

What does the 'P' in DOPES stand for?

Pneumothorax Assessment.

What does the 'E' in DOPES stand for?

Equipment Failure Assessment.

What does the 'S' in DOPES stand for?

Secretions Assessment.

What specific clinical conditions warrant gastric port suctioning?

Known or suspected gastric secretions following SGA placement; Evidence of emesis after device insertion; Persistent difficult ventilation despite comprehensive troubleshooting efforts; Failed improvement with standard airway management techniques.

What is the critical timing difference for SGA gastric port suctioning compared to tracheal suctioning?

SGA gastric port suctioning allows up to 15 seconds, while standard tracheal suctioning is limited to 10 seconds.

What is a safety consideration when selecting a catheter for gastric port suctioning?

Using oversized catheters can damage the gastric port or become entrapped; undersized catheters may provide inadequate suction capability.

How is the catheter length measured externally for SGA gastric port suctioning?

Measure catheter length against the external portion of the I-Gel from the gastric port opening to the proximal end of the device.

What is the purpose of marking the catheter with tape?

To provide visual reference during insertion and prevent excessive advancement.

What is the first step in preparing the I-Gel gastric channel for catheter insertion?

Apply a small bolus of lubricant to the proximal end of the gastric channel.