UNIT FOUR
570
Clinical Skills and Care
Suctioning the tube is considered a sterile procedure because it goes deep into the trachea, and poor technique could intro- duce pathogens into the lungs. The sterile suction catheter is inserted using sterile technique through the endotracheal tube, and suction is applied as the catheter is pulled outward. Some suction catheters are inside a sleeve of clear plastic, keeping the catheter itself sterile but allowing you to touch the outside of the sleeve without the need to put on sterile gloves. Skill 28.7 gives the steps in performing endotracheal suctioning using a sleeved catheter. Tracheostomy A tracheostomy, an incision into the trachea that is held open with a tube to promote breathing, may be performed for several reasons. If a patient has had an endotracheal tube in place for 7 to 10 days and will require longer-term ventila- tor support, a tracheostomy usually is performed. A tracheos- tomy is also performed when the airway is obstructed, either temporarily or permanently. In many cases, the obstruction is caused by cancerous tumors in the laryngeal area. Because the endotracheal tube can erode the trachea after being in place longer than 2 weeks, the tracheostomy is nec- essary. First, an incision is made into the trachea, called a tracheotomy. Then the shorter tracheostomy tube is inserted directly into the trachea and anchored in place. The ventila- tor is then attached to the tracheostomy tube. A tracheostomy tube has three parts (Fig. 28.8): 1. The outer cannula, with or without a cuff. The cuff is in fl ated to prevent air leakage when the patient is on a ventilator, just as it is on the endotracheal tube. The cuff on the tracheostomy tube should remain in fl ated while the patient eats to prevent aspiration of food or fl uids. Most hospitals have a policy for de fl ating the cuff
FIGURE 28.6 A Yankauer or tonsil-tip suction tube (from Wilkinson JM, Treas LS, Barnett, KL, et al. Fundamentals of Nursing: Theory, Con- cepts & Applications. Vol. 1. 4th ed. Philadelphia, PA: FA Davis; 2020).
Endotracheal Airways Some airways are designed to enter the trachea, not the phar- ynx. These airways are used when the patient is unable to breathe independently because of airway obstruction or respiratory arrest. An endotracheal tube is a fi rm but fl ex- ible plastic tube that may be inserted through the nose or the mouth. The tube usually is inserted by a physician or specially trained respiratory therapist. These tubes are often placed in the surgery suite to support ventilation during sur- gery. Their purpose is to connect the patient to the ventila- tor so that oxygen and air are delivered directly to the lungs. The positive pressure of the ventilator causes the air to go into the lungs. To ensure that air does not exit through the trachea around the tube, the endotracheal tube contains an in fl atable cuff located near the distal end. When the cuff is in fl ated, air can- not leak around the tube but goes completely into the lungs for full ventilation (Fig. 28.7). SUCTIONING AN ENDOTRACHEAL TUBE. Patients with endotracheal tubes are cared for in critical care settings.
Outer tube with cuff and inflating tube
Cuff
Inner cannula
Obturator
FIGURE 28.7 An endotracheal tube placed through the mouth and into the trachea with the cuff inflated to prevent air leaks (from Wilkinson JM, Treas LS, Barnett, KL, et al. Fundamentals of Nursing: Theory, Concepts & Applications. Vol. 1. 4th ed. Philadelphia, PA: FA Davis; 2020).
FIGURE 28.8 A tracheostomy tube with inflatable cuff and "pillow," inner cannula, and obturator (from Williams LS, Hopper PD. Understanding Medical-Surgical Nursing. 6th ed. Philadelphia, PA: FA Davis; 2019).
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