Clinical Skills Lab Notes

Flashcards for review

Guedel's Airway

One type of artificial airway.

Laryngeal Mask

A type of artificial airway.

Endotracheal Tube

A type of artificial airway.

Tracheostomy Tube Types

Differ primarily in whether they are 'cuffed' or not; fenestrated tubes and Passy-Muir Valves (for speech) are also available.

Tracheostomy Cuff Pressure Measurement

Measured to ensure an air-tight seal, preventing aspiration or air leaks (if under PPV); use a manometer at the start of every shift or when judged necessary.

Communicating with a Tracheostomy Patient

Requires non-verbal methods due to the inability to speak. Include E devices, iPads, texts, pen and paper, whiteboard, sign language. Nurses require patience.

Tracheostomy Stoma and Neck Monitoring

Monitor the tracheostomy site for signs of infection, bleeding, irritation, and skin excoriation from tracheostomy ties.

Criteria for Stoma Care

Routine tracheostomy care on every shift and PRN as dictated by the state of the wound, according to ward protocol & individual requirements; use Normal Saline or a weak solution of aqueous chlorhexidine.

Equipment for Tracheostomy Dressing

Dressing pack; saline or aqueous chlorhexidine; towel; Tracheostomy ties; split dressing; rubbish bag.

Frequency & Solutions for Tracheostomy Stoma Care

According to ward protocol and individual requirements. Use either normal Saline or a weak solution of aqueous chlorhexidine.

Assistance During Tracheostomy Tube Change

Important to avoid accidental de-cannulation.

Ensuring Correct Tracheostomy Tape Tightness

Should be able to fit two fingers comfortably under the trache tape.

Humidification

Use of warmed & moistened air via a mask or nasal prongs and is intended for ongoing use.

Nebulization

Method of medication delivery via the airway, creating a fine mist of medication for inhalation via a mask.

Humidification with Artificial Airway

Used to deliver medications; for humidification in any situation where the use of dry oxygen and/or medical air is ongoing, especially when the upper airway has been bypassed by a tracheostomy.

Observations Indicating Need for Tracheostomy Suctioning

Falling saturations (late sign), increased WoB, audible sputum (gurgling/bubbling), attempting to cough, showing signs of distress.

Patient Preparation for Suctioning

Re-assure patient, pt consent for invasive procedure, position in Fowler's position if possible, hyper oxygenate for 1 - 2 minutes prior

Hypoxia During Suctioning

Occurs because suctioning removes not only secretions but also air from the lungs hence the need for pre-oxygenation before suctioning.

Catheter Insertion Depth

Enough to reach just above the Carina.

Avoiding Catheter Reinsertion

Do not reinsert a catheter used for oral pharyngeal suctioning into the tracheal tree to avoid infection; the oro-pharyngeal space is not sterile.

Data Supporting Clear Airways

Patent airway, clearance of secretions, improved breath sounds, improved air entry, good pulse, oximetry readings, and improvement in respiratory distress in a patient, no increased WoB.

Suctioning Procedure Modification with Cuffed Tracheostomy Tube

Leave suction catheter insitu as cuff is deflated in order to catch any secretions which may have collected on or above the cuff, do on second/third instance.

Emergency Bedside Equipment for Tracheostomy Patient

Laerdal bag with appropriate face mask and a 'liquorice stick', two spare tracheostomy tubes (cuffed), tracheal dilators in sterile package, Yankeur sucker with tubing.

Tracheostomy Complications

Occluded trache tube lumen (suctioning), accidental de-cannulation (tracheal dilators), Tracheal Malacia (minimise cuffed tube time), Infection (wound monitoring).

Indications for Nasal Humidification

oxygen therapy > 4 hours requires humidification of oxygen, option to increase air flow and not fraction of inspired oxygen, exacerbation COPD.

Contraindications for HFNP (High Flow Nasal Prongs)

Mid-facial trauma; suspected/untreated pneumothorax, upper airway obstruction

Benefits of Nasal Humidification Delivery Systems

pt comfort, increased humidified air flow up to ward policy limit

Urgent Medical Review

30 minutes time response.

MET Call

5 minutes time response.

Code Blue

2 minutes time response.

Resuscitation Process Steps

DRSABCD

Potential Dangers in Resuscitation

Environmental/situational hazards; electricity/chemical spill/water, Unknown infectious health status of victim

Checking for Patient Response

Ask their name, ask loudly are you alright, squeeze their shoulders.

Opening and Maintaining Airway During Basic Life Support

Head tilt/chin lift or jaw support.

Airway Adjuncts

jaw support, guedels

Assessing for Signs of Breathing

look, listen, feel

Hand Position for Compressions

Adults: two hand technique, Children: one or two hand technique can be used, Infants: two finger technique.

Rate for Cardiac Compressions

100-120 per minute.

Depth of Cardiac Compressions

At least 5cm the lower half of the sternum should be depressed approximately one third of the depth of the chest with each compression.

Breathing to Compression Ratio

2:30 (2 breaths every 30 compressions).

Airway for Child/Neonate

Adults + children >1 yr are managed the same, suitable size air viva

When to Connect AED

ASAP

AED Precautions

Follow the prompts: care should be taken not to touch the person during shock delivery.

AED Steps

follow the automated prompts

CVC Locations

Neck: internal jugular vein, Chest: subclavian vein, Groin: femoral vein

CVC Indications

Monitor central venous pressures, rapidly infuse fluids during resuscitation, blood products, administer medications

PICC Indications

Infuse chemotherapy, IV nutrition, blood sampling, administration of medications for a short period of time

PORTACATH Indications

can be left in for an extended period of time, same indications as a CVC but has the advantage of not visible on the outside of the body

HICKMAN indications

same indications as a CVC but has the advantage and can be left in for an extended period of time

CVAD location confirmation

CXR

Closed system

one way connection with stopcock and valve eg Clave system

Blood culture results time

early results within 24 hours of your blood tests. But you might need to wait 48 to 72 hours to learn what kind of yeast or bacteria is causing your infection

Patient Position for CVC removal

Position patient supine with head slightly down. Lying patient flat reduces risk of air embolus by increasing central venous pressure