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SA Sx - Pulmonary Sx 2

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drraythe's version from 2017-10-10 13:42

Tracheotomy & tube tracheostomy (DONT CALL IT AN ET TUBE)

Question Answer
Why is there a metal spring in the T-tube?Keep it from kinking (not all of them have the metal bit)
When do you do a Tracheotomy & tube tracheostomy?If need to bypass resp for a bit to let it rest
How do you go about Sx preparing for placing the tube? (short+sweet w pics)Place stay sutures to position tracheal tube. Incision through membrane horizontally, or longitudinal splitting cartilage. Insert tube. Gauze around tube w/ ABx ointment & then tie around neck. Cleaned daily.
Specific way you go about inserting the T-tube?Place stay suture (distal cart, sometimes prox) gonna leave stay suture long so can open trach when cleaning or removing tube & placing new one. So 2 better bc open easier. Lift cat, introduce trach tube, inflate cuff & then split gauze place at base of tube, w/ some ABx cream & then tie tube around the neck. Needs to be cleaned on daily basis. Coupage useful bc help get rid of mucus
How wide should you clip/what should the incision be like?clip wide - distance of fingers in pic is about how long the incision should be
When making incision for T-tube placement... which structures must you be careful of?Ventral vein on trachea, careful not to hurt thyroids, dont hurt recurrent laryngeal n
When making incision for T-tube placement.. Size blade? How much of circumference to cut?Incision 11-15 blade - dont go beyond 40% circumference of trachea or will cz more damage
What should you know about the stay sutures placed for this procedure?1 on cr incision ring & 1 on ca incision ring. Thick suture, used for manipulating trach & opening. Can leave them in for later manipulation, tie around T-tube on outside
What should maintenance care be like for the T-tube?Clean every day & flush it
what is this? What is it used for?This is quick track (respiratory catheter) curved needle. This special curved needle & on top, the cath thing thats curved & short. Idea is w/o cutting or dissecting you can piercing w/ stylet, insert cath into trachea, pull out stylet & then connect to breathing system to ventilate PTx (quick track) ER way to access trach. (Can make your own if you need to: 3cc syringe w/ old connector, take plunger out. & 16-18 g needle)
How do you perform a permanent tracheostomy?dissect trachea & remove small block of it. Pass horizontal mattress sutures from sternohyoideus & thyroidus-slide them underneath. Bring mm against each other underneath trachea & push trachea upwards towards skin - preventing tension from sutures. Will suture mucosa to the skin creating a permanent opening into the trachea. 3.5 -4 cm incisions-prevent shrinking. Simple interrupted
*How big should you make your tracheostomy opening?3.5-4cm rule to acct for shrinking!!!
*If you are going to do a permanent tracheostomy on a dog, what rules should you lay down for the owners now?*CANT GO SWIMMING ANYMORE *buy bandana to protect form rocks & grass & such - keep fur trimmed & clean, clear mucus
3 ways to retrieve a tracheal FB?(1) Bronchoscopy & grasping equipment
(2) Balloon catheter retrieval
(3) Tracheotomy - rarely indicated
What kinda cellular damage can tracheal FB do?Can cz necrosis & sloughing of mucosa - need to maintain ciliary & goblet system
What's that awful FB that can migrate through tissues & make your life horrible?Grass awns
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