Care of aLlenLs 8equlrlng Cxygen

1herapy or 1racheosLomy
Cxygen 1herapy
Pypoxemlalow levels of oxygen ln Lhe blood
Pypoxladecreased Llssue oxygenaLlon
Coal of oxygen LherapyLo use Lhe lowesL
fracLlon of lnsplred oxygen (llC2) for an
accepLable blood oxygen level wlLhouL causlng
harmful slde effecLs
aC2 parLlal pressure of arLerlal oxygen
Cxygen lnLake and Cxygen
uellvery
Pazards and CompllcaLlons of Cxygen
1herapy
CombusLlonC2 ls noL flammable buL lnflames
no peLro producLs near C2 source
Cxygenlnduced hypovenLllaLlonln Lhose wlLh C2
vs CC2 drlven chemorecepLors use C2 dellvery
meLhod LhaL ls preclse eg venLurl mask
Cxygen LoxlclLyCx?CLn lS A MLulCA1lCn
concenLraLlon duraLlon condlLlon 30 C2
causes mlld changes s/s dry cough ss chesL paln
dyspnea nausea decreased compllance hyallne
memb dls use leasL posslble
Pazards and CompllcaLlons of Cxygen
1herapy
AbsorpLlon aLelecLaslsC2 dlluLes
nlLrogenalveolar collapse
urylng of mucous membranesany C2 flow
4L/mln musL be humldlfled or nebullzed
wlLh sLerlle P2C
lnfecLlon humldlfler or nebullzer grows
bacLerla/fungus
Lowllow Cxygen uellvery
Nasa| Cannu|a
1L/min = 24%
For each 1/L = 4%
6L/min = 44%
,9 IAC ,A 3L/mln 40
38L/mln 4060
9art|a| rebreather mask
611 L/mln 6073 keep bag 2/3 full
Nonkebreather mask 101S$m|n809S
flow Lo keep bag 2/3 full
Plghllow Cxygen uellvery
SysLems
Ientur| mask mosL accuraLe C2 dellvery
mask uses porLs wlLh dlfferenL slzed lnLakes
or dlals wlLh varylng slzed lnLake holes
Iace tent faclal Lrauma
Aeroso| mask hlgh humldlLy
@racheostomy co||ar resLs over Lrache
openlng
1leceaLLaches Lo Lrache Lube
vLn1u8l MASk
vLn1u8l
venLurl Mask 2430 aL 410 L/mln
1lece 24100 + aerosol aL 10L
nonlnvaslve oslLlveressure
venLllaLlon
1echnlque uses poslLlve pressure Lo keep alveoll open
and lmprove gas exchange wlLhouL alrway lnLubaLlon
|9A9mechanlcal dellvery of seL poslLlve lnsplraLory
pressure each Llme Lhe paLlenL beglns Lo lnsplre as
Lhe paLlenL beglns Lo exhale Lhe machlne dellvers a
lower seL endexplraLory pressure LogeLher lmprovlng
Lldal volume
C9A9conLlnuous poslLlve alrway pressure
ConLlnuous oslLlve Alrway ressure
(CA)
ConLlnuous nasal oslLlve Alrway
ressure
1echnlque dellvers a seL poslLlve alrway
pressure LhroughouL each cycle of lnhalaLlon
and exhalaLlon
LffecL ls Lo open collapsed alveoll
aLlenLs who may beneflL lnclude Lhose wlLh
aLelecLasls afLer surgery or cardlaclnduced
pulmonary edema lL may be used for sleep
apnea
1ransLracheal Cxygen uellvery
used for longLerm dellvery of oxygen dlrecLly
lnLo Lhe lungs
Avolds Lhe lrrlLaLlon LhaL nasal prongs cause
and ls more comforLable
llow raLe prescrlbed for resL and for acLlvlLy
18AnS18ACPLAL only C2 dellvery
Pome Cxygen 1herapy
CrlLerla for home oxygen Lherapy equlpmenL
?ou aln'L glLLln no C2 lf you aln'L below aC2
of 33mmPg or yo SaC2 83 on room alr
aLlenL educaLlon for use
Compressed gas ln a Lank or cyllnder
Llquld oxygen ln a reservolr
Cxygen concenLraLor
Cxygen 1herapy
CCnCLn18A1C8
1racheosLomy
1tocbeotomy ls Lhe surglcal lnclslon lnLo Lhe
Lrachea for Lhe purpose of esLabllshlng an
alrway
1tocbeostomy ls Lhe sLoma or openlng LhaL
resulLs from Lhe procedure of a LracheoLomy
rocedure may be Lemporary or permanenL
necessary lf cannoL lnLubaLe 2
nd
Lrauma
anaLomy
1hls porLralL Lhough
undaLed supporLs Lhe vlew
LhaL LracheoLomy was
pracLlced ln anclenL hlsLory
1racheosLomy
nurslng ulagnoses
lmpalred Cas Lxchange
lnfecLlon
CommunlcaLlon
Cral mucous membranes
Soclal lnLeracLlons
lnLervenLlons
reoperaLlve caredlscuss Lype of Lube and
communlcaLlon needs keeplng Lube paLenL
CperaLlve proceduressuLured ln
osLoperaLlve careensure secure paLenL
alrway
osslble compllcaLlons assessmenL
@ube obstruct|onLhlck mucous or cuff problem
s/s peak pressures on venLllaLor
@ube d|s|odgment# lf wlLhln 72 hrs
afLer placed could be lodged ln subq Llssue
manua| bag mask send for help CPLCk Su8C
LMP?SLMA whaL should be aL bedslde?
lnLervenLlons
AccldenLal decannulaLlon wlLhln 72 hrs keep
1rache Lray Lrache wlLh obLuraLor aL bedslde
osL 72 hrs exLend neck open sLoma Lo
secure an alrway lnserL obLuraLor Lhen Lrache
Check for alrflow bllaL 8reaLh sounds
lf noL secure manual bag wlLh mask call for
help or 881 or Lhe oLher 881
CLher osslble CompllcaLlons
Assess for
neumoLhorax aL apex
SubcuLaneous emphysemanoLlfy md
8leedlngmlnlmal
lnfecLlonsLerlle Lechnlque change dresslng
frequenLly every hour or prn afLer new Lrache due
Lo large amL mucous
uo noL cuL gauze LhaL ls placed near Lrache
1racheosLomy 1ubes
ulsposable or reusablemosL dlsposable meLal
Lrache cauLlon ln M8l
Cuffed Lube or Lube wlLhouL a cuff for alrway
malnLenance lf noL venLllaLed no cuff
needed
lnner cannula dlsposable or reusable musL
be cleaned every few hours or as needed
lenesLraLed Lubecap only lf lnner cannula
removed
and cuff deflaLed
1racheosLomy 1ubes
1racheosLomy Lube wlLh cannula
lenesLraLed 1racheosLomy 1ube
Care lssues for Lhe 1racheosLomy
aLlenL
revenLlon of Llssue damage
Cuff pressure can cause mucosal lschemla 14
20mmPg or 23cmP2C
use mlnlmal leak Lechnlque and occluslve
Lechnlque
Check cuff pressure aL leasL 2 x each shlfL May
need Lo lncr cuff pressure lf venL eak prss
30mmPg or LL 10mmPg
revenL Lube frlcLlon and movemenL malnLaln
mlnlmum pressures sLablllze sucLlon only lf
needed
revenL and LreaL malnuLrlLlon hemodynamlc
lnsLablllLy or hypoxla
Cuff ressures
Alr Warmlng and PumldlflcaLlon
1he LracheosLomy Lube bypasses Lhe nose and
mouLh whlch normally humldlfy warm and
fllLer Lhe alr
Alr musL be humldlfled
MalnLaln proper LemperaLure
Lnsure adequaLe hydraLlon
SucLlonlng
CnL? ll A1lLn1 lS unA8LL 1C CCuCP u
MuCCuS
ll CAn CCuCP LACL PuMlulllL8 lLCL
CvL8 18ACPL Anu kLL CLLAn
ALLCW 1PLM 1C CCuCP u MuCCuS
SucLlonlng 00 lT 6FtTlY
When? 8esLless anxlous look aL paLlenL's
face nolsy breaLhlng
Lachycardla/dysrhyLhmla C2 desaL
Lachypnea peak pressure alarm on venLllaLor
SucLlonlng malnLalns a paLenL alrway and
promoLes gas exchange
Assess need for sucLlonlng from Lhe paLlenL
who cannoL cough adequaLely chesL moves
buL no resulL
SucLlonlng ls done Lhrough Lhe nose or Lhe
mouLh use nasopharyngeal Alrway lf freq
Lhrough nose
SucLlonlng (ConL'd)
SucLlonlng can cause
Pypoxla (see causes Lo follow)
1lssue (mucosal) Lrauma
lnfecLlon
vagal sLlmulaLlon and bronchospasm
Cardlac dysrhyLhmlas from hypoxla caused by
sucLlonlng
C2 vla sucLlon Lube? 383
CPA81 303 384 SuC1lCnlnC A81lllClAL
Al8WA?"
T TL
MLASu8L l8CM 1PL 18ACPL CLnlnC 1C
1PL CA8lnAA vL8? SPC81 ulS1AnCL
L1 1u8L MLASu8L MCu1P 1C AnCLL Cl
LCulS A1 1PL CA8lnA Anu Auu LLnC1P Cl
L1 1u8L Cu1 Cl MCu1P C8 nCSL
AvClu Pl11lnC 8LSlS1AnCL 1PlS lS Pl11lnC
1PL CA8lnA
Causes of Pypoxla ln Lhe
1racheosLomy
lneffecLlve oxygenaLlon before durlng and
afLer sucLlonlng
use of a caLheLer LhaL ls Loo large for Lhe
arLlflclal alrway AdulLs 1214 lr Chlld 6
10 lr
rolonged sucLlonlng Llme 1013 sec may
aLelecLasls
Lxcesslve sucLlon pressure 80120 mmPg
1oo frequenL sucLlonlngsucked Lhe llfe rlghL
ouL of 'em Pome seLLlng use CLLAn" meLhod
osslble CompllcaLlons of
SucLlonlng
1lssue LraumaLoo freq Loo long Loo sLrong non
roLaLlon 881 applles sLerlle sallne down Lrache
Lhen bags Lhen sucLlons
lnfecLlon of lungs by bacLerla from Lhe mouLh
closed clrculL 8allard caLheLer
vagal sLlmulaLlonsLop sucLlonlng lmmedlaLely
and oxygenaLe paLlenL manually wlLh 100
oxygen
vLach block brady low bp asysLole monlLor
8ronchospasmmay requlre a bronchodllaLor
1racheosLomy Care
AssessmenL of Lhe paLlenLsucLlon lf needed
CLLAn every shlfL or agency pollcy oral
hyglene anLlbacLerlal soluLlon
Secure LracheosLomy Lubes ln placechange or
clean Lles every day
revenL accldenLal decannulaLlonapply new
Lles before removlng old
C1 1Cu8 percusslon vlbraLlon
8ronchlal and Cral Pyglene
1urn and reposlLlon every 1 Lo 2 hr supporL
ouLofbed acLlvlLles encourage early
ambulaLlon
Coughlng and deep breaLhlng chesL
percusslon vlbraLlon and posLural dralnage
promoLe pulmonary cure
Cral hygleneavold glycerln swabs or
mouLhwash LhaL conLalns alcohol assess
mouLh for ulcers bacLerlal or fungal growLh
or lnfecLlons
nuLrlLlon
Swallowlng can be a ma[or problem for Lhe
paLlenL wlLh a 1racheosLomy Lube ln place
lf Lhe balloon ls lnflaLed lL can lnLerfere wlLh
Lhe passage of food Lhrough Lhe esophagus
LlevaLe Lhe head of bed for aL leasL 30 mlnuLes
afLer Lhe paLlenL eaLs Lo prevenL asplraLlon
durlng swallowlng
Speech and CommunlcaLlon
aLlenL can speak wlLh a cuffless Lube
fenesLraLed Lube or cuffed fenesLraLed Lube
LhaL ls capped or covered
aLlenL can wrlLe
hrase quesLlons Lo paLlenL for yes or oo
answers
A oneway valve LhaL flLs over Lhe Lube and
replaces Lhe need for flnger occluslon can be
used Lo asslsL wlLh speech
lenesLraLed 1racheosLomy
1ube
Weanlng from a 1racheosLomy
1ube
Weanlng ls a gradual decrease ln Lhe Lube slze
and ulLlmaLe removal of Lhe Lube
Cuff ls deflaLed as soon as Lhe paLlenL can
manage secreLlons and does noL need asslsLed
venLllaLlon
Weanlng from a 1racheosLomy
1ube (ConL'd)
Change from a cuffed Lo an uncuffed Lube
Slze of Lube ls decreased by capplng use a
smaller fenesLraLed Lube
1racheosLomy buLLon has a poLenLlal danger
of geLLlng dlslodged