WordPress.com
| |
| |
| |
| |
| |
| |
|Patient preparation: |
| |
|Consent has been obtained. |
| |
|Ensure that the patient has been fasted 6 hours prior to procedure. |
| |
|Aspirate naso-gastric tube and place on free drainage. |
| |
|Review patient’s most recent laboratory data: U/Es, FBC, and Coagulation. |
| |
|Check that blood sample has been obtained for group & save. |
| |
|Check that anti-coagulation has been withheld (acceptable to administer previous day at 6pm). |
| |
|The patient is sedated and paralysed and hyper-oxygenated with 100% BIPAP mode. |
| |
|Immediate access to suction is required. Check that suction apparatus is functioning. |
| |
|Suction the patient’s oro-pharynx and endotracheal tube. |
| |
|The patient is positioned with 2-3 towels rolled under the shoulders to maximally extend the neck. |
| |
| |
| |
|Essential equipment: |
| |
|Sterile percutaneous tracheostomy tray |
| |
|Spare ET tube and gum-elastic bougie. |
| |
|Laryngoscope and suction. |
| |
|Fibre-optic scope, light source and assistant to operate. |
| |
|Portex connector or catheter mount. |
| |
|Percutaneous tracheostomy set (TRACHOE experc), marking pen and sterile lubricant jelly. |
| |
|500ml 0.9% sodium chloride. |
| |
|Sterile pack with: fenestrated drape, 2% chlorhexidine sponge and scalpel. |
| |
|Sterile gown, gloves, surgical cap and surgical facemask. |
| |
|Lignocaine with 1/200000 adrenaline: stored in refrigerator. |
| |
|2/0 hand-held stitch, tracheostomy fixation tape & keyhole dressing. |
| |
| |
|What happens during the procedure? |
| |
|Two members of the medical team are required for the procedure: Consultant Intensivist and Registrar. |
| |
|The Consultant Intensivist (or Registrar) will stand at the head of the bed to maintain the patient’s airway during the transition from ET to tracheostomy|
|tube. |
| |
|Anticipate that ventilator settings may require adjustment. |
| |
|The bedside nurse monitors the patient’s heart rate and rhythm, blood pressure, respiration and oxygen saturations and ventilator recordings. |
| |
|The Consultant Intensivist (or Registrar) prepares and drapes the anterior neck. A small vertical incision is then made around the midline of the |
|patient’s neck, between the 1st and 2nd or the 2nd and 3rd tracheal rings. |
| |
|The Anaesthetist standing at the head of the bed suctions the patient’s oro-pharynx, loosens the tape around the existing ET small vertical incision is |
|then made around the midline of the patient’s neck, tube, deflates the ET tube cuff & withdraws the tube to a level just below the vocal cords. At this |
|point, the ventilator settings may require adjustment in order to compensate for the air leak created when the cuff is deflated. |
| |
|The person standing at the head of the bed operates the bronchoscope, inserting it through the ET tube so that the instruments can be visualised as they |
|are advanced through the tracheal wall. |
| |
|Once the tracheostomy tube is in place, the cuff is inflated and ventilation through the tube is confirmed by assessment of breath sounds. The ET tube is|
|removed, the patient is suctioned. |
| |
|The tracheostomy site is cleaned and sutured in place and secured with tracheostomy fixation tapes. Sutures remain in situ for 7 days. |
| |
|A chest x-ray is required at the end of the procedure. |
| |
|End-tidal CO2 monitoring is required. |
| |
|The fibre-optic scope requires to be cleaned as per unit policy. |
| |
|Emergency equipment: ensure trachi-case is assembled as per unit policy. |
| |
| |
|Post procedure care: |
| |
|A chest x-ray is required at the end of the procedure. |
| |
|End-tidal CO2 monitoring is required. |
| |
|The fibre-optic scope requires to be cleaned as per unit policy. |
| |
|Emergency equipment: ensure trachi-case is assembled as per unit policy. |
| |
|Observe for bleeding. Slight bleeding may occur at the insertion site, but should resolve as healing occurs. Change keyhole dressing if heavily |
|saturated. Inform medical staff if bleeding is excessive or persistent. Monitor Haemoglobin/Full Blood Count and Coagulation. |
| |
|Observe for major bleeding: bleeding from the tube may indicate a mucosal tear or tracheal wall injury and may require endoscopic examination. |
| |
|Devised by: Mairi Mascarenhas Clinical Educator ICU. |
|Reviewed: November 2013. |
-----------------------
PERCUTANEOUS TRACHEOSTOMY PROCEDURE
INTENSIVE CARE UNIT RAIGMORE HOSPITAL
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- propofol dosing guidelines
- massachusetts board of registration in nursing
- flushing midline and central line iv catheters
- guideline for the insertion management replacement and
- intrathecal chemotherapy administration
- site marking verification for invasive procedures
- central line policy
- nursing policy manualincontinence care
Related searches
- wordpress passing data between pages
- wordpress business templates
- wordpress rss feed not working
- wordpress jquery is not defined
- create wordpress blog
- wordpress roles editor
- wordpress full rss feed
- wordpress rss feed settings
- wordpress rss feed plugin
- wordpress display rss feed
- wordpress rss feed link
- wordpress rss feed to post