Airway – Change Tracheostomy

MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C56081.B99A6C00" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C56081.B99A6C00 Content-Location: file:///C:/B133D633/SP3.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Airway – Change Tracheostomy

Airway – Change Tracheostomy

Clinical Indications:

= ______ 1.      Pres= ence of a tracheostomy site.

= ______ 2.      Urge= nt or emergent indication to change the tube, such as obstruction that will =

not<= /span> cle= ar with suction, dislodgement, or inability to oxygenate, and/or ventilate the patient without other obvious explanation.

Procedure:

= ______ 1.      Have= all airway equipment prepared and ready for standard airway management, includi= ng equipment for orotracheal intubation and failed airway.
= ______ 2.      Have airway device (endotracheal tube or tracheostomy tube) of the same size as = the currently placed tracheostomy tube as well as 0.5 smaller size available (if the patient has a #6.0 Shilley, a 6.0 and a 5.5 endotracheal = tube is required.)

= ______ 3.      Lubr= icate the replacement tube(s) and check the cuff.

= ______ 4.      Remo= ve the tracheostomy tube from the mechanical ventilation device and ventilate with= a bag valve mask to pre-oxygenate the patient.

= ______ 5.      Once= all equipment is in place, remove the devices that secure the existing tracheos= tomy tube, including sutures and-or supporting bandages.

= ______ 6.      If applicable, deflate the cuff on the tracheostomy tube. If unable to aspirate air with a syringe, cut the balloon off and allow cuff to lose pressure.

= ______ 7.      Remo= ve the tracheostomy tube.

= ______ 8.      Inse= rt the prepared replacement tube.

= ______ 9.      Conf= irm placement via standard measures excluding esophageal detection (as it is ineffective for surgical airways.)

= ______ 10. If resistance is met upon insertion, remove and re-attempt with the smaller tu= be.

= ______ 11. If difficulty is still encountered, use standard airway procedures such as bag valve mask or endotracheal intubation (as per protocol). More difficulty with a tube cha= nge can be anticipated for tracheostomy sites that are immature (less than two weeks old). Great caution sho= uld be exercised with these types of sites.

= ______ 12. Docu= ment procedure, confirmation, patient response, and any complications in the electronic PCR.

Certification Requirements:

Succ= essfully complete a biannual evaluation including the indications, contraindications, technique, and possible complications of the procedure.

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