Egans CH 37 Tracheostomies

Vocabulary flashcards covering key terms and concepts from the tracheostomy lecture notes.

Translaryngeal intubation

Endotracheal intubation passed through the larynx for airway ventilation (oral or nasal route); reevaluated daily with consideration of duration and potential transition to tracheostomy.

Extubation

Removal of the endotracheal tube; often planned within days of intubation; if extubation is unlikely, consider tracheostomy.

Tracheostomy

Surgical opening in the neck to access the trachea

Tracheotomy

Procedure of establishing access to trachea via neck incision, can be traditional surgical or percutaneous dilational, procedure best performed by physician/surgeon in surgical setting after pts airway is stabilized, tube selection depends on patient age, size, weight, and airway anatomy.

Tracheostomy tube

Tube placed via a tracheostomy to maintain airway; includes components such as outer cannula, flange, inner cannula, cuff, connectors, obturator, rounded tip, inflation tube, pilot balloon, & one way valve.

Outer cannula

The main, immovable tube that stays in the trachea to maintain the airway.

Inner cannula

Removable lumen inside the outer cannula; can be disposable or reusable and is cleaned/replaced as needed.

Cuff

Inflatable balloon on the tracheostomy tube used to seal the airway and secure ventilation.

Pilot balloon

Small balloon connected to the cuff used to monitor and adjust cuff inflation via the inflation tube.

Inflation tube

Channel connecting the pilot balloon to the cuff for cuff inflation and pressure monitoring.

Flange

External neck stay that stabilizes and positions the tracheostomy tube.

15-mm adapter

Standard connector that attaches the tracheostomy tube to ventilator circuits or breathing hoses.

Obturator

Insertion guide used during tracheostomy tube placement to facilitate smooth insertion.

One-way valve (Passy-Muir valve)

A valve that allows inhalation through the trach and directs exhaled air through the upper airway to enable phonation.

Hollow inner cannula

An inner cannula that provides a hollow lumen inside the outer cannula for airflow and is removable for cleaning.

Rounded tip

The smooth, rounded end of a tracheostomy tube designed to minimize mucosal injury during insertion and use.

I.D. / O.D. (tracheostomy tube sizes)

Inner diameter and outer diameter measurements used to match tube size to patient anatomy.

Fenestrated tracheostomy tube

A tube with fenestrations (holes) that allow air to pass through the upper airway, aiding phonation.

Montgomery T-tube

A T-shaped tracheal stent used to maintain patency in stenotic tracheas and for long-term airway management.

Adv. of Montgomery T-tube

• Maintained w/ reconstructed or stenotic tracheas

• Allows use of upper airway for phonation/ must occlude limb (b)during speaking

• Can be used long-term

• Tailored fit for diff. anatomies, ages, sizes

• T-shape prevents dislodgement, more secure in airway (post insertion)

Disadv. of Montgomery T-tube

• Anesthesia & vent challenges: does not use universal adaptor/connectors

• Insertion risks

• Maintenance complexity: careful cleaning & monitoring to prevent blockage/infection

Tracheoesophageal voice prosthesis (TEP)

A prosthetic device that channels air from the lungs to the esophagus to produce voice after laryngectomy.

Laryngectomy

Surgical removal of the larynx (voice box), commonly for cancer, trauma, & radiation necrosis; creates a permanent stoma for breathing.

Laryngectomy tube (laryngectomy tube / lary tube)

Tube inserted into the laryngectomy stoma to keep the airway open during healing.

Laryngectomy stoma

Permanent airway opening created after laryngectomy that remains for ventilation and breathing.

Speaking valve (Passy-Muir valve)

A one-way valve that enables phonation by redirecting exhaled air through the upper airway.

Cricothyroidotomy kit

Emergency equipment used to establish a rapid airway via the cricothyroid membrane.

Decannulation

Removal of a tracheostomy tube; part of the weaning process; may involve fenestrated or double-cannulated tubes, caps, or buttons.

Double-cannulated tube

Tracheostomy tube with an additional channel to allow fenestration and airway access above the cuff for weaning, has an opening in the posterior wall of outer cannula above cuff.

Tracheostomy caps

Occlusive caps used during weaning to close the stoma and test airway tolerance.

Tracheostomy buttons

Small devices placed in the stoma to cap and manage airway during weaning.

Laryngeal lesions

Most common injuries to the larynx such as glottic edema, vocal cord inflammation, ulcerations, vocal cord polyps or granulomas.

Vocal cord paralysis & stenosis

Less common, loss of movement in the vocal cords, a potential airway injury associated with tracheal tubes.

Tracheomalacia

Weakening or softening of tracheal cartilage causing tracheal collapse, especially with prolonged intubation.

Tracheal stenosis

Narrowing of the trachea, potentially from prolonged intubation or tracheostomy.

Tracheoesophageal fistula (TEF)

Abnormal connection between the trachea and esophagus, a serious complication of airway devices.

Tracheoinnominate artery fistula (TIF)

Life-threatening fistula between the trachea and the innominate artery.

Foam cuff

A cuff design that seals the trachea at atmospheric pressure by expanding the cuff; used in certain pts who already have tracheal injury.

Tight-to-shaft cuff (TTS)

Low-volume, high-pressure cuff design, maximizes airflow around tube when deflated; should be inflated with sterile water only to avoid air leaks and tissue damage due to being made of porous silicone material.

Ultrathin polyurethane cuff

A newer cuff material/shape that forms a cylinder or inverted pear shape to minimize channels and seal effectively.

Airway pressures 20-30 cm H2O

Target range for cuff/airway pressures to reduce tracheal wall injury.

Swivel adapter

Device that reduces tube movement/traction and stabilizes the airway tube.

Weaning from tracheostomy

Process of gradually decreasing dependence on the tracheostomy tube, often using fenestrated or double-cannulated tubes, caps, or buttons.

Phonation

Voice production; in tracheostomy patients, often achieved via speaking valves or TE prostheses.

What is the primary cause of injury w/ tracheal tubes?

Tube movement

What can sedation help avoid?

Self-extubation

Which tubes are easier to stabilize?

Nasotracheal tubes

How can you treat airway trauma associated w/ tracheal tubes?

• Laser therapy for small lesions

• Resection & end-to-end anastomosis can be indicated when damage involves < 3 tracheal rings

• Staged repair & stends may be required for more involved damages

Steps of tracheostomy care?

1. Assemble & check equipment

2. Explain procedure to pt.

3. Suction pt.

4. Remove inner cannula (if present), if non-disposable: clean, if disposable: will replace w/ new, clean

5. Clean & examine stoma site

6. Change ties/holder

7. Replace clean inner cannula (if present)

8. Reassess pt.