Inhaltsverzeichnis
Werbung
Verfügbare Sprachen
Verfügbare Sprachen
EN
•
Ensure that the correct Luer connectors are used (e.g. 2a +
7a).
•
During insertion and removal of the tube, irritation, the need
to cough or bleeding may occur.
7.
Adverse Reactions
Pressure points, skin irritation, granulation tissue, the need to cough,
difficulty swallowing and bleeding.
8.
Inserting the Tube
8.1
Preparing the Tube
1.
Check the pack content for completeness (D).
2.
For tubes with a cuff, check the cuff (2) for leakage by inflat-
ing it. For this purpose, inflate the cuff with a handheld manometer,
for example the TRACOE cuff pressure monitor REF 720, to a pres-
sure of 50 cm H
O (≈ 36.78 mm Hg) and wait for 1 minute to see
2 2
whether the cuff becomes deflated. If the cuff is leak-tight, remove
all air from the cuff with a syringe. Push the cuff upwards in the
direction of the neck flange (5) to facilitate insertion. If there is any
leakage, use a replacement tube and return the defective product as
instructed in Chapter 13.
8.2
Preparing the Patient
•
Ensure that the patient is well pre-oxygenated before cannu-
lation or recannulation.
•
Slightly overextend the patient's neck, if possible, to facilitate
insertion.
•
In case complications arise during cannulation or recannula-
tion, a tube with a smaller diameter should be at hand for emer-
gency use. In addition, take appropriate safety measures that allow
the doctor to carry out short-term ventilation using translaryngeal
intubation or a laryngeal mask.
8.3
Inserting the Tube
Carry out the following steps:
1.
When inserting the tube (1), take care that the obturator (6) is
not inadvertently pushed back into the tube. This can easily be pre-
vented by holding both the tube and obturator firmly with one hand.
To aid insertion, apply a thin layer of water-soluble lubricant to the
protruding part of the obturator at the patient end and to the adja-
cent section of the tracheostomy tube, including the cuff.
2.
Once the tube has been inserted into the patient's trachea,
remove the obturator immediately.
3.
For ventilation, securely connect the inner cannula with the
14
standardised 15 mm connector (3) to a ventilation machine.
For Cuffed Tubes:
4.
Inflate the cuff via the filling valve (2a). Adjust the cuff pres-
sure to the individual ventilation therapy and check at regular inter-
vals. Typically, the pressure should be between 20 cm H
15 mm Hg) and 30 cm H
O (≈ 22 mm Hg).
2 2
A fall in cuff pressure occurs when a handheld manometer is
attached. This effect is more pronounced with smaller tubes.
5.
Attach the neck strap (12) to the neck flange (5) to fix the
tube in place on the patient's neck.
6.
Check the position of the tube as well as its correct function
(see Chapter 6 "Warnings"). If required, carefully suction the trachea
and tube to ensure that the airways are unobstructed.
7.
Now check the cuff pressure to ensure that the cuff has not
been damaged during insertion.
8.4
Removing the Tube
Prepare to remove the tube as follows:
•
Bend the patient's head slightly backwards and
•
Completely deflate the cuff of cuffed tubes (see Chapter 8.5).
8.5
Deflating the Cuff
Before deflating the cuff, ensure that as little secretion as possible
can enter the bronchia.
While the cuff is being deflated, secretions should be removed using
a suction catheter inserted through the tube. If a tube with subglottic
suction has been used, the subglottic space should also be suc-
tioned before deflating the cuff, see Chapter 9.5.
To deflate the cuff, connect a syringe with a standard male Luer
connecter to the filling valve (2a). Completely remove all air/any pos-
sible condensate
If the cuff cannot be deflated, the following measures should be
taken:
•
Remove the inner cannula. Ensure that the inflation line (2b)
is not kinked and repeat the deflation of the cuff.
•
If it is still not possible to remove the air/condensate from the
cuff, carefully cut through the inflation line between the 15 mm con-
nector (3) and the neck flange (5).
9.
Handling
9.1
Changing the Inner Cannulas
If viscous secretion collects in the inner cannula and cannot be suc-
EN
O (≈
2 2
15
Werbung
Inhaltsverzeichnis
