NURS3805 Module 1: Tracheostomy Care and IV Therapy

What is a tracheotomy?

sterile surgical incision into the trachea through the skin and muscles to establish an airway

What is a tracheostomy?

stoma/opening from tracheotomy to secure an open airway

Why can patients with a tracheostomy not speak?

the stoma is below the vocal chords so air can not pass by the vocal chords to produce sound

How is the cuff of a tracheostomy pumped up?

by injecting air into the pilot balloon

What is the function of a tracheostomy cuff?

- often used when pt is on a ventilator

- to help push air out of the stoma instead of going up

- minimizes risk of aspiration

What is the outer cannula of a tracheostomy?

the main, permanent part of the tracheostomy tube that is inserted directly into the trachea

What is the inner cannula of a tracheostomy?

removable, smaller tube that fits inside the outer cannula

What is the obturator of a tracheostomy?

a curved, rigid tube that's used to guide a tracheostomy tube into the trachea during insertion or when changing the tube

Compare single vs double lumen cannula tracheostomies.

single:

- just outer cannula

- make sure to suction secretions to keep airway patent

double:

- outer and inner cannula

- removable inner cannula to clean or replace

Compare cuffed vs uncuffed tracheostomies.

cuffed:

- balloon inflates to seal off the upper and lower airway

- used for mechanical ventilators

uncuffed:

- allows pt to pass air around the trach

- allows for speech production

- pt must be a low aspiration risk

What is a fenestrated cannula?

cannula has openings to allow the pt to start weaning off the trach and speak

What are the purposes of a tracheostomy dressing?

- to catch any secretions from the trach

- to prevent skin breakdown

How does the nurse assess a patient's need to have their trach suctioned?

- auscultate for crackles

- tachypnea

- gurgling or rattling sounds

- decreased O2 saturation

Is tracheostomy suctioning a sterile or clean procedure?

sterile

How often should a tracheostomy be suctioned?

q 8 hrs or more often PRN

What should the nurse do in between suctioning a patient's trach?

- provide at least 60 seconds of recovery time

- monitor the patient's O2 saturation

- assess for signs of respiratory distress

- replace O2 if being used

What is the Yankauer suction tip used for?

- to remove secretions from the mouth and throat

- NOT for suctioning tracheostomies

What position should a patient be in when they are having their tracheostomy suctioned?

- semi-fowler's

- fowler's

- high fowler's

What are some common reasons for a patient having venous access?

- to balance fluids in the body

- to administer medications

What is normal saline mainly used for?

fluid replacement

What IV solution is administered with blood products?

0.9% NaCl (normal saline)

What concentration of Na and Cl are in normal saline?

154 mEq/L of each

What does it mean when a nurse "primes" an IV line?

running fluid through the tube to remove all the air

What is the drop factor?

the number of drops (gtts)/ml

What are the steps to prepare an IV solution?

- check the order to verify the solution and dose

- obtain bag of IV fluids and compare it to the order

- check the bag for expiration rate

- obtain IV tubing noting the drip factor and length of tubing

- put on gloves

- clamp the tubing

- remove the sterile caps off the bag and tubing

- spike the bag using sterile technique

- unclamp the tubing

- prime the line

- reclamp the tubing

What is a PICC line?

peripherally inserted central catheter: inserted into the brachial area of the arm and into the superior vena cava

What is a peripheral IV?

IV inserted typically in the arm or hand

Are PICC line changes a sterile or clean procedure?

sterile

Why does removal of a PICC line require special care?

to prevent air embolism

What is used to clean the IV site?

- alcohol

- chlorhexidine gluconate (CHG)

How can a nurse find an IV site?

- lower the extremity

- apply warmth

- instruct pt to open and close fist

- vein finder

What areas should be avoided when inserting an IV?

- lymphedema

- surgical site

- active infection

- arm on the side of a mastectomy

- arm with a fistula

What are common veins used for IV insertion?

- brachial vein

- radial vein

- ulnar vein

- palmar arches

Why should a nurse start IV insertions at the hand and move closer to the heart?

if the vein is blown, they can not insert another IV below the blown vein

What are the steps to insert an IV?

- put on gloves

- apply the tourniquet

- clean skin at site for 30 seconds or according to policy

- allow skin to dry completely

- hold the skin taught below site with nondominant hand to anchor the vein

- insert IV catheter into the vein at a 10-15 degree angle with the bevel up

- look for blood return in the flash-back chamber

- advance the needle 2mm further into the vein

- remove the tourniquet

- apply pressure to the vein at the tip of the cannula

- remove the needle and dispose in the sharps container

- apply dressing to IV site

- flush site with NS

What should be used when administering medications through IV push?

10cc syringe

What is the purpose of flushing an IV line?

to assesses patency of the line and vein

What should be used to flush an IV?

10cc syringe of sterile NS

What always needs to be done before attaching anything to an IV port?

clean the valves on the IV with alcohol

What are the 2 ways to set an IV rate?

- by hand with the roller clamp

- with IV pump machine

Which bag should be hung higher: the piggyback or primary bag?

the piggyback bag

What is required when changing a PICC line dressing?

- special kit

- sterile technique

- masks worn by everyone in the room

What are the steps to remove an IV?

- stop the flow of the solution

- remove the tape

- put on gloves

- remove catheter ensuring it is intact

- cover site with gauze and apply pressure

- clean site with alcohol

- apply dressing or bandage

What does the nurse look for when assessing an IV site?

- infiltration

- phlebitis

- tissue trauma at the site

- infection

What is infiltration of an IV?

when fluid leaks under the skin instead of into the vein

What is phlebitis?

inflammation of a vein