Fahl SPIRAFLEX Instrucciones De Uso página 19

If an insertion aid is used, this must then immediately be removed from the tracheostomy tube.
The tracheostomy tubes should always be attached with a special tube holder. This stabilises the tube
and thus ensures that the tracheostomy tube is securely seated in the tracheostoma (see picture 1).
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1.1 Inflating the low-pressure cuff (if present)
The low-pressure cuff is inflated by applying a defined pressure to the cuff via the Luer connection
(standardised conical connection) of the inflation tube by means of a cuff pressure gauge
(e.g.MUCOPROTECT , REF 19500). If not instructed otherwise by the doctor/physician, we
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recommend a cuff pressure of at least 15 mmHg (20 cmH2O) to 18 mmHg (25 cmH2O). The cuff
pressure should never under any circumstances exceed 18 mmHg (approx. 25 cmH2O).
Inflate the low pressure cuff at most to this target pressure and check to make sure that sufficient air
is supplied via the tracheostomy tube. Always make sure that the low-pressure cuff is undamaged
and in perfect working order. If the desired sealing is not achieved even after trying repeatedly with the
specified limit volume, a tracheostomy tube with larger diameter may be indicated.
The correct cuff pressure must be checked regularly, i.e. at least every 2 hours.
CAUTION!
All instruments used for inflating the cuff must be clean and free of foreign particles! Detach the
instruments from the Luer connection of the inflation tube as soon as the cuff has been inflated
and close the connection with the cap.
CAUTION!
If the maximum pressure is exceeded for longer periods of time, the blood circulation in the
mucus membrane can be impaired (risk of ischaemic necrosis, pressure ulcers, tracheomalacia,
tracheal stenosis, pneumothorax). In patients undergoing artificial respiration, the cuff pressure
should not be allowed to drop below the cuff pressure value specified by the doctor/physician
in order to prevent unnoticed aspiration. Hissing noises in the region of the balloon, especially
during expiration, indicate that the trachea is insufficiently sealed by the balloon. If the trachea
cannot be sealed with the pressure values specified by the doctor/physician, the entire air should
be withdrawn again from the balloon and the sealing process should be repeated. If this does not
lead to success, we recommend to use the next larger tracheostomy tube with balloon. Due to the
permeability of the balloon wall for gases, it is normal for the pressure in the balloon to decline
slightly over time, but it can on the other hand also rise unintentionally during gas anaesthesia.
Regular pressure monitoring is therefore urgently recommended.
The cuff must never under any circumstances be inflated with excessive amounts of air, since
this can lead to damage of the tracheal wall, tears in the low pressure cuff with subsequent
deflation, or distortion of the cuff, in which case airway obstruction cannot be ruled out.
CAUTION!
During anaesthesia, the cuff pressure can rise/fall due to nitrous oxide (laughing gas).
2. Removing the tube
CAUTION!
Accessories such as a tracheostoma valve or HME (Heat Moisture Exchanger) must be removed
first before proceeding to remove the Fahl tracheostomy tube.
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CAUTION!
If the tracheostoma is unstable, or in emergency situations (puncture/dilation tracheostomy),
the tracheostoma can collapse after withdrawal of the tracheostomy tube, thereby impairing air
supply. A fresh tracheostomy tube must be kept ready for use in such cases and must be quickly
inserted if necessary. A tracheal dilator (REF 35500) can be used for temporarily securing the
air supply.
The cuff must be emptied before removing the tracheostomy tube. The head should be tilted
back slightly for removal of the tube.
CAUTION!
Never use a cuff pressure gauge to empty the low-pressure cuff. Always use a syringe for this.
Before the air is removed from the balloon by means of a syringe and the tracheostomy tube is
withdrawn, the region of the trachea above the balloon must first be cleaned by suctioning off
secretions and mucus. If the patient is responsive and reflexes are intact, it is recommended that the
patient be suctioned while at the same time unblocking the tracheostomy tube. Suctioning is performed
by inserting a suction catheter through the cannula tube into the trachea. In this way, suctioning can
be performed without any problems and gently for the patient and cough stimulus and the risk of
aspiration are minimised.
Next, deflate the low pressure cuff while suctioning off at same time. If secretions are present,
these are now taken up by the suction tube and can no longer be aspirated. Please note that the
tracheostomy tube must in every case be cleaned, if necessary disinfected, and lubricated with
stoma oil as specified below prior to reinsertion.
Proceed very carefully to avoid injury to the mucus membranes.
The tube must always be cleaned and, if necessary, disinfected as follows before re-inserting
according to the instructions provided below.
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