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•
After removing the insertion system, ensure that the silicone sleeve is still located on the
guiding catheter. If not, the silicone sleeve (radiopaque) must immediately be removed from the
tube or airway.
•
During initial placement of a tracheostomy tube immediately stop the ventilation through the
upper airways when the cuff of the inserted tracheostomy tube is inflated. This reduces the risk of
barotrauma.
•
Ensure that the cuff is not punctured by instruments or sharp tracheal cartilage ridges.
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Use only water-soluble lubricating gel for tracheostomy applications, as oil-based gel may
damage the tube.
•
Ensure that the tube does not become obstructed when applying lubricating gel to the
inserter/obturator tip.
•
Check the position and function of the tube following insertion. Incorrect placement may
result in permanent damage to the tracheal mucosa or minor bleeding.
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Do not move or shift the tube once it is in position, as this may damage the stoma/trachea
or lead to insufficient ventilation.
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For correct orientation of the tube and adjustable neck flange, it is essential, that the scale
on the tube faces upwards (cranial) and the distal end of the tube is oriented caudal. The informa-
tion engraved on the neck flange must be readable (TRACOE logo towards patient's chin;
see Image 2).
•
To avoid damage to the cuff material it should not be in contact with local anesthetics
containing aerosols or any ointments, i.e. dexpanthenol.
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Long-term and excessive cuff pressure above 30 cmH
permanent damage to the trachea.
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Only fill the cuff with air. Do not fill the cuff with liquids as this would lead to cuff pressure
peaks above 30 cmH
2
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Insufficient filling (below 20 cmH
an increased risk of aspiration, which may result in the worst case in VAP (ventilator associated
pneumonia) or aspiration pneumonia.
•
When repositioning the patient, while in bed, ensure that the patient does not lie on the pilot
balloon, as this could increase the cuff pressure and potentially damage the trachea.
•
To prevent damage to the stoma or trachea, ensure that the cuff is deflated (empty) prior to
insertion or removal of the tube. If it is not possible to deflate the cuff, cut the inflation line with a
pair of scissors and remove the air. In this event, the product is defective and must be replaced.
•
During air travel alteration of the cuff pressure may occur. Therefore, ensure permanent cuff
pressure control.
•
Before deflating the cuff ensure that the patient`s upper respiratory tract is unobstructed.
When applicable, clear the upper respiratory tract of any secretions through suction or patient
coughing.
•
Make sure that the correct Luer connectors are used for filling the cuff (transparent) and
suctioning (white).
•
Make sure that the correct Luer connector (white) is used for ACV.
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Ensure that the tracheostomy tube is free of obstructions which may lead to reduction of
the provided airflow. Therefore, regular suctioning of the secretion inside the tube is recommended.
•
Excessive viscous secretion may lead to dislocation of the tracheostomy tube. Ensure the
correct placement of the tube by regularly checking of the tube position and reduce the risk of
dislocation by subglottic suctioning of the secretion.
•
Use only suction catheters to clear the secretions from the patient`s respiratory tract and
the tracheostomy tube. Instruments may wedge in the tube and restrict ventilation.
•
Regularly check that all connections are secure to prevent an inadvertent disconnection of
the tube from external equipment and ensure efficient ventilation.
•
Keep the 15 mm connector clean and dry.
O.
O) of the cuff could result in insufficient ventilation and/or
2
O (≈ 22 mmHg) poses a risk of
2
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