When the Trach tube comes out, how do you ventilate the patient? - page 2

by chiuli | 31,861 Views | 20 Comments

I can't find this in my book anywhere, when the trach comes out accidentaly, and you want to ventilate the patient with the ambu bag, do you ventilate their mouth or their stoma? I always thought you would ventilate the stoma but... Read More


  1. 0
    Awesome, Grey Gull!
  2. 0
    So let me make sure I got this clear:
    A tracheotomy is an incision into the trachea to put the tube in while a tracheostomy is a procedure where the doctor takes the trachea and pulls it out through the neck to make a stoma
  3. 0
    If you can simply make an incision into the trachea (tracheotomy) and put the tube in, why bother doing the tracheostomy? What would happen if you left a person with a tracheotomy in place for long term?
    Also, how is the care different for the two patients?
  4. 0
    I have seen real RN's who sadly know very little about this subject, let alone a nursing student who is trying to absorb this information
  5. 1
    No (HORRORS! Pulling the trachea out..!!!) the tracheotomy is the surgical procedure of making an opening into the trachea for the purpose of establishing an airway in a person whose upper airway is obstructed. You got that right, but the resultant opening is kept patent by insertion of a tube, of which there are different types. This opening is called a stoma, hence the name tracheostomy. The trachea is not pulled out! Unless, of course, you have a grudge against that particular patient...
    Last edit by GHGoonette on Oct 10, '10 : Reason: Minor correction
    xtxrn likes this.
  6. 0
    Threads on like subjects merged and thread moved to Nursing Student Assistance forum where the OP can receive assistance for this homework question.
  7. 1
    The main thing is to know is what type of opening the patient has and where it goes or doesn't go. Then you can more easily refer to the proper P&P in your manual.



    Quote from Christine Cameron-Do
    No (HORRORS! Pulling the trachea out..!!!) the tracheotomy is the surgical procedure of making an opening into the trachea for the purpose of establishing an airway in a person whose upper airway is obstructed. You got that right, but the resultant opening is kept patent by insertion of a tube, of which there are different types. This opening is called a stoma, hence the name tracheostomy. The trachea is not pulled out! Unless, of course, you have a grudge against that particular patient...
    This depends on the type of surgeries done in your hospital. Some doctors like to differentiate between -otomy as the incision meant to close when something is not there holding it open and -ostomy with the ostomy being more permanent and will not close once the trach is removed.

    I have also posted a photo here of a stoma being formed when the trachea is brought to the surface. It is a HORRORS! photo and I apologize if some are squeamish. (Google Images is a great tool - yeah that posters and graphics display thing again)


    To form an -ostomy (according to the purist of ENTs surgeons), after a laryngectomy the trachea is brought to the surface and the stoma is formed. A more permanent ostomy or stoma can also be created without the laryngectomy if the patient needs tracheal access but still has their larynx some upper airway access. Of course many use the terms interchangeably and may not actually realize what their patient has.

    Example of a stoma s/p laryngectomy (you are looking directly into the trachea)

    http://www.dwp.gov.uk/img/laryngeal-cancer.jpg

    In the above photo you will see a little tag stick out which is a prosthetic speaking valve (Blom-Singer) that fits into the fistula between the trachea and esophagus.

    Below is a neck resection with laryngectomy where the trachea is being prepared to form a stoma at the surface.
    http://www.rborl.org.br/conteudo/ace...gura2-68-5.jpg

    Text that goes with that photo:
    http://www.google.com/imgres?imgurl=...IoG2sAODopTeBA

    Diagram of a tracheostomy s/p laryngectomy.
    http://www.macmillan.org.uk/Cancerin...ryngectomy.gif

    This is a tracheotomy incision that needs a little TLC and Bacitracin.
    http://amamasblog.com/wp-content/upl...incision-2.jpg

    Tracheotomy incision with a trach
    http://www.rch.org.au/emplibrary/ward8west/trache_3.jpg

    Note that there is still an intact trachea above the trach.
    Last edit by GreyGull on Oct 13, '10
    VickyRN likes this.
  8. 3
    A big thanks to GreyGull for your amazing insight and knowledge. Thank you for so freely sharing out of your vast reservoir of expertise. I have learned much from your posts on this thread.

    Moderator's friendly reminder: This thread has been moved to the Nursing Student Assistance Forum. This is a safe place (in other words, a haven) for students to come asking for help without being dissed by the membership. All unhelpful and off topic comments on this thread (that threaten to derail the thread) have been and will be removed. All references to these unhelpful comments have also been removed. Thank you and carry on...
  9. 1
    :bowingpur

    Thanks, Grey Gull, your diagrams and even the HORRORS! piece are joining my notes!
    xtxrn likes this.
  10. 0
    ive had my trach for 12 years now and its only came out one time.
    Last edit by sherri1234567 on Nov 6, '11


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