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352
Index
Anatomy (continued)
tongue, 3
trachea, 11–13
Anesthesia, 21–25
complications with, 25
hemorrhage, 25
pneumothorax, 25
cuff changes with, 172–173
emergence from, 25
equipment for, 22–23
induction of, 23
maintenance of, 23 –25
monitoring for, 23
premedication for, 22
preoperative evaluation for, 21–22
technique, 22
Angioneurotic edema, 18, 19
Antidisconnect device, 110
Arcadia Adjustable-Neck Flange
tracheostomy tubes, 79
diameters of, 122
Arcadia Foam Cuff tracheostomy
tubes, 67
diameters of, 122
Arcadia Silicone Air Cuff tracheostomy
tubes, 65
diameters of, 122
Arcadia Silicone CTS Cuff tracheostomy
tubes, 69
capping of, 186
diameters of, 123
positive-pressure ventilation patients
with, 197
Arcadia Silicone Cuffless tracheostomy
tubes, 74
diameters of, 122
Aryepiglottic fold, 4
Arytenoid, 5
ASA. See American Society of
Anesthesiologists
Balloon valve, 42
Benzodiazepine, tracheostomy tube change
with, 146
Bivona cap, 107
Bivona Fome-Cuf, 46
Bivona Fome Cuff tracheostomy tubes,
diameter of, 123
Bivona Fome-Cuf With Talk Attachment
tracheostomy tubes, 77
diameters of, 134
Bivona Hyperflex tracheostomy tubes, 78
diameters of, 123
Bivona laryngectomy tubes, 93
diameters of, 134
Bivona Mid-Range Aire-Cuf tracheostomy
tubes, 64
diameters of, 123
Bivona Sleep Apnea tracheostomy tubes,
74 –75
diameters of, 124
Bivona TTS cuff, 46
Bivona TTS tracheostomy tubes, 68 – 69
capping of, 186
diameters of, 124
positive-pressure ventilation patients
with, 197
Bivona Uncuffed tracheostomy tubes, 70
diameters of, 124
Bjork flap, 29
Blom decannulation plug, 108
Blom tracheostomy tube system, 102–103,
205 –207, 334 –335
diameters of, 134
Bronchial hygiene, 163
Bronchial hygiene therapy, tracheostomy
tubes with, 329 –331
Bronchorrhea, tracheostomy tubes with,
331
Bronchoscope, guidance for PDT
with, 31–32
Caps, 106 –107
Bivona, 107
phonation/cuffless tube with, 186 –187
Shiley, 106
Cartilage
cricoid, 5, 11
paired, 11
pyramidal arytenoids, 6
thyroid, 10
Cellulitis, 174 –175
Child
airway anatomy of, 13 –15
decannulation in, 319
PDT contraindicated for, 32
tracheotomy, 37
Child tracheostomy, 243 –263
bleeding with, 254 –255
changing tube with, 249
decannulation from, 261–262
criteria for, 261
Index
353
inpatient, 261–262
outpatient, 262
developmental issues with, 255 –262
activity, 255 –256
behavioral, 255 –256
language, 256 –259
emergency care for, 253
general care for, 248
home care of
physiologic monitoring in, 252–253
resources for, 251–252
humidification for, 250
indications for, 244, 245
infection with, 253 –254
language development with, 256 –259
children 0 –3 months, 256
children 3 – 6 months, 256 –257
children 6 –9 months, 257
children 9 –12 months, 257
children 12–15 months, 257–258
children 15 –36 months, 258
middle/preteen years, 259
preschool/elementary years, 258 –259
management in community of, 251–255
medications with, 250 –251
pulmonary, 251
outcome with, 244 –246
precautions while bathing with, 248 –249
procedural steps in care with, 246 –255
respiratory distress with, 253
school attending with tube from, 261
shape of stoma with, 254
speaking valve use with, 259 –261
contraindications for, 260
suctioning for, 249 –250
tube selection for, 246 –248
Chronic obstructive pulmonary disease
(COPD), 22
Compliance, 162
Complications/emergency
procedures, 277–299
anesthesia management, 25
classification of, 277–278
early postoperative, 285 –291
external stomal erosion, 288 –289
infection, 253 –254, 289 –290
internal stomal erosion, 288
pneumomediastinum, 290 –291
postobstructive pulmonary edema,
291
subcutaneous emphysema, 290
tube displacement/loss of airway,
285 –286
tube obstruction, 120, 286 –287
emergency child tracheostomy care
as, 253
intraoperative, 280 –285
air embolism, 283 –285
hemorrhage, 280 –281
intraoperative fire, 281–283
pneumothorax, 281
late postoperative, 291–299
granuloma formation, 294 –295
stomal granulation tissue, 294 –295
tracheal stenosis, 296 –299
tracheocutaneous fistula, 293 –294
tracheoesophageal fistula, 292–293
tracheoinnominate fistula/
hemorrhage, 292
tracheomalacia, 295 –296
COPD. See Chronic obstructive pulmonary
disease
Corks, 108
phonation/cuffless tube with, 186 –187
Cough
retained secretions, defense mechanism
for, 163
strength of, 119 –120
poor cough reflex with, 331
Cranial nerves, 10
facial, 10
glossopharyngeal, 10
hypoglossal, 10
trigeminal, 10
vagus, 10
Cricoid cartilage, 5, 11
Cricothyroid ligament, 5
Cricothyroid muscles, 25
Critically ill patient
airway pressures with, 161–162
time to tracheotomy with, 160 –161
tracheostomy for, 160 –163
work of breathing with, 162–163
Cuff, 42, 43, 45 – 47
barrel-shaped, 45 – 46
Bivona Fome-Cuf, 46
Bivona TTS, 46
care of, 216 –218
changes at altitude with, 169 –172
changes with anesthesia with, 172–173
deflated, 46
evolution of, 45
354
Index
Cuff (continued)
foam-type, 46
inflated, 46
leaks around, 165 –169
cuff inflated but air leaking, 166 –167
cuff inflated but tube small for airway,
166
cuff not fully inflated, 165
patient position changes causing,
167
patient with high PEEP causing,
167–168
tracheomalacia with, 168 –169
leaks around tube with, 169
leaks in, 164 –169
algorithm for, 170
leaks within, 164 –165
low-pressure, 48
Portex Blue Line, 46
purpose of, 45
shapes of, 46
Shiley SCT, 46
teardrop-shaped, 46
Cuffed fenestrated tracheostomy tube,
201–203
Decannulation. See Downsizing/
decannulation
Decannulation plugs, 108
Blom, 108
Shiley, 107
TRACOE, 108
Deglutition, phonation with, 15
Depression, tracheostomy patient home
care with, 344 –345
Digital occlusion, 183 –186
cuffless or deflated cuff only for, 183
Disconnect wedges, 106
Disposable inner cannulas, 109 –110
Portex Per-Fit, 109
Shiley DIC, 109
Shiley SIC, 109
Double-cuffed tracheostomy tubes, 99
Downsizing/decannulation, 303 –320
after, 318 –319
children with, 319
factors to consider prior to, 304 –309
cannulation times, 306 –307
future artificial airway need, 309
initial tracheostomy placement
reasons, 307–309
resistance/work of breathing, 304 –306
tube size, 309
failure with, 319
protocol for, 311–318
readiness for, 309 –311
Dual-cannula cuffed tracheostomy tubes,
47–54
Portex DIC, 51
Portex Flex DIC, 52–53
Portex Lo-Profile, 54
Portex Per-Fit, 51
Shiley DCT, 49
Shiley LPC, 48
Shiley PERC, 50
TRACOE Twist Series, 53 –54
Dual-cannula cuffless tracheostomy tubes,
54 – 61
Portex DIC Uncuffed, 55
Portex Flex DIC Uncuffed, 56
Portex Lo-Profile Uncuffed, 60 – 61
Shiley CFS, 57
Shiley DCFS, 58
TRACOE Comfort, 60
TRACOE Twist Cuffless, 59
DuoDERM, 174 –175
Dynamic compliance, 162
Eliachar speaking valves, 192
Emergency kit, 211–212
Emergency procedures. See
Complications/emergency
procedures
Emphysema, subcutaneous, 290
Endotracheal intubation
timing of, 19
tracheotomy v., 19
Endotracheal tube (ETT), 8
Epiglottis, 4, 9 –10
functional anatomic relevance of, 9 –10
physiology of swallowing with, 9 –10
Epiglottitis, 18
ETT. See Endotracheal tube
Extra-long tracheostomy tubes, 77 – 83
Arcadia Air Cuff Adjustable-Neck
Flange, 79
Bivona Hyperflex, 78
Portex Blue Line Extra Horizontal
Length, 82– 83
Shiley TracheoSoft XLT, 80
TRACOE Comfort Extra Long, 82
TRACOE Vario, 81
Index
355
Facial nerve, 10
Fenestrated tracheostomy tubes, 93 –99,
149 –152, 338
airflow with, 188
change/placement of, 151–153
Jackson, 98–99
phonation with, 187–189
Portex Blue Line, 96
Portex Blue Line Ultra, 96
Portex DIC, 95
Portex Flex DIC, 95 –96
Portex Lo-Profile, 96
Shiley, 94–95
TRACOE Comfort, 98
TRACOE Twist, 97
Fentanyl, 23, 24
Fire, intraoperative
management of, 283
prevention of, 282–283
tracheostomy complicated by, 281–283
Flap valve, 190
Foam cuff tracheostomy tube, change/
placement of, 150 –151
Glossopharyngeal nerve, 10
Granuloma formation, tracheostomy
complicated by, 294 –295
Heat moisture exchanger, 110
Hemilaryngectomy, 267
swallowing after, 268
Hemodynamic instability, speaking valves
use contraindicated by, 196
Hemorrhage
management of, 280 –281
prevention of, 280
tracheoinnominate fistula, 292
tracheostomy complicated by, 280 –281
tracheotomy anesthesia complicated
by, 25
Holinger laryngectomy tubes, 134
Holinger tracheostomy tubes, 85
diameters of, 134
Home care, tracheostomy patient,
232–236
activities of daily living with, 235 –236
emergency care with, 342
family members with, 232–233
managing emergencies with, 234 –235
Medicare reimbursement with,
342–344
psychosocial costs with, 344 –347
body image, 346 –347
caregiver burden, 345 –346
depression, 344 –345
quality of life, 345
rehabilitation/recovery in, 341–347
suctioning with, 233 –234
teaching for, 233, 341
tracheostomy care/supplies with,
341–344
tracheostomy cleaning with, 341–342
Hood speaking valve, 194
Hood stoma stent, 104 –105
Hood T-tube, 230
Humidification
airway, 227–228
child tracheostomy with, 250
Hyoid bone, 4, 5
Hypoglossal nerve, 10
IMPACT, 161
Infection
child tracheostomy with, 253 –254
tracheostomy complicated by, 289 –290
Inflammation, 174 –175
Inflation line, 42, 45
Infraglottic space, 4
Inspiration, vocal cords position during,
6 –7
Jackson fenestrated tracheostomy tubes,
98 –99
Jackson laryngectomy tubes, 135
Jackson tracheostomy tubes, 84 – 85
diameters of, 131
Kisner valve, 190
Laryngectomy
considerations for patient with,
265 –275
postoperative care after, 267
quality of life with, 273 –274
speech after, 270 –272
surgical-prosthetic voice restoration
for, 270 –272
swallowing after, 268 –270
one-way valve with, 269
radiographic study of, 268
tracheostomy with assessment/
therapy for, 269 –270
356
Index
Laryngectomy (continued)
types of, 266 –267
hemilaryngectomy, 267
supraglottic laryngectomy, 266
total laryngectomy, 196, 267
ventilator-dependent tracheostomized
patients with, 272–273
breathing with, 272–273
speech with, 272–273
swallowing with, 272–273
Laryngectomy tubes, 88 –93
Air-Lon, 134
Bivona, 93, 134
diameters of, 134 –137
Holinger, 134
Jackson, 135
Martin, 135
Portex DIC, 89– 90, 135
Provox LaryTube, 91, 136
Shiley LGT, 89, 136
Singer, 92, 136
TRACOE Comfort, 91, 137
TRACOE Twist, 90, 137
Laryngoscopy, tongue during, 3
Larynx, 5 –9, 14
anatomy of
anterior view, 5
arytenoid in, 5
cricoid cartilage in, 5, 11
cricothyroid ligament in, 5
functional relevance, 6 –9
hyoid bone in, 4, 5
pyramidal arytenoids cartilages in, 6
recurrent laryngeal nerve in, 6 – 8
sagittal view, 5
thyrohyoid ligament in, 5
thyroid cartilage in, 5, 10
vocal cords in, 6 –7
Leak speech
anxiety/discomfort with, 199
PEEP added for, 199
phonation for ventilation requiring
patients with, 332–334
phonation with, 198 –201
quality of life improved with, 198
speaking valve with, 199 –201
Lidocaine, open tracheotomy with, 26
Low-pressure cuff (LPC), 48
LPC. See Low-pressure cuff
Luer tracheostomy tubes, 88
diameters of, 132
Martin laryngectomy tubes, 135
Martin tracheostomy tubes, 87
diameters of, 132
Mayo Clinic tracheostomy tubes, 87
diameters of, 132
Mechanical ventilation
airway pressures with, 161–162
laryngectomy/tracheostomized
patients and
breathing with, 272–273
speech with, 272–273
swallowing with, 272–273
phonation for patients requiring, 333,
334
time to tracheotomy with, 160 –161
tracheostomy patient on, 160 –163
tracheostomy patients without
requiring, 183 –196
tracheostomy patients with
requiring, 197–207
work of breathing with, 162–163
Medicare reimbursement, tracheostomy
patient home care, 342–344
Metal tracheostomy tubes, 41, 83 – 88, 130
cleaning of, 216
Holinger, 85
Jackson, 84 – 85
Luer, 88
Martin, 87
Mayo Clinic, 87
Tucker, 86
Mini-tracheostomy tubes, 101
Montgomery cannula, 105
Montgomery Safe-T-Tubes, 100 –101
Montgomery speaking valve, 190 –192
Montgomery Ventrach, 192–193
Moore tracheostomy tubes,73
diameters of, 124
Mouth, 2–3
functional anatomic relevance of, 3
Nasal mucosa, 2
Neck flange, 45
Neck plate. See Neck flange
Nomori ventilator talking tracheostomy
tube, 205
Nose, 2
functional anatomic relevance of, 2
Nutrition, 232
Nylon tracheostomy tubes, cleaning
of, 216
Index
357
Obese patients, PDT contraindicated for, 32
Obstructive sleep apnea (OSA), size of
pharynx with, 5, 14
Obturator, 44–45
Olympic tracheostomy button, 103 –104
Olympic Trach Talk, 191
Open tracheotomy, 26 –30
Bjork flap in, 29
horizontal incision for, 27
incision with spreaders for, 28
initial incision for, 27–28
landmarks for, 26, 27
lidocaine used in, 26
palpation of neck landmarks at start of, 26
patient positioning for, 26 –27
pretracheal fascia dissected in, 28
setting for, 26
thyroid gland in, 28
thyroid isthmus exposure in, 27, 29
tracheal ring removal, 28 –30
tracheotomy dilator used in, 29
vertical incision for, 27
Oral care, 229
Oropharyngeal muscle, 3
OSA. See Obstructive sleep apnea
Paired cartilage, 11
Paranasal sinuses, 2
Passy-Muir speaking valves, 191–192
PDT. See Percutaneous dilational
tracheotomy
Peak pressure, 161–162
Pediatric airway anatomy, 13 –15
Pediatric tracheotomy, 37
landmarks with, 37
nylon traction sutures in, 37
tube position in, 37
PEEP. See Positive end-expiratory
pressure
Percutaneous dilational tracheotomy (PDT),
30 –37
bronchoscopic guidance with, 31–32
contraindications to, 32
children, 32
obese patients, 32
criteria for, 32
guidewire insertion in, 32, 34 –36
history of, 30 –31
insertion of needle in, 32–33
patient positioning for, 32
Seldinger technique with, 30
PFT. See Pulmonary function tests
Pharynx, 3 –5
anatomy of
functional relevance, 3 –5
oropharyngeal muscle in, 3
gas exchange with, 4
OSA with, 5, 14
pathogens with, 4
Phonation
algorithm for, 186
deglutition with, 15
larynx with, 14
methods for, 183, 185
capping/corking/plugging for, 186 –187
cuffed fenestrated tracheostomy tube
for, 201–203
cuffless fenestrated tracheostomy
tube for, 187–189
digital occlusion for, 183 –186
leak speech for, 198 –201, 332–333
speaking valves for, 189 –196
talking tracheostomy tube for,
203 –207
tracheostomy with, 181–207
patients requiring continuous
mechanical ventilation, 197–207
patients with intermittent positive
pressure ventilation, 196 –197
patients without mechanical
ventilation, 183 –196
requirements for success
during, 182–183
risk of aspiration with, 182
voice restoration principles
for, 181–183
tube choice with, 144 –145
ventilation requiring patients with,
331–335
leak speech with, 332–334
mechanical ventilator adjustment for,
333, 334
tracheostomy tubes characteristics
with, 335
vocal cords position during, 6 –7
Pilot balloon, 43, 45
Pistoning, 169
Plateau pressure, 161–162
Plugs
Blom, 108
decannulation, 106–108
phonation/cuffless tube with, 186 –187
358
Index
Plugs (continued)
Shiley, 107
TRACOE, 108
Pneumomediastinum, tracheostomy
complicated by, 290 –291
Pneumothorax
management of, 281
prevention of, 281
tracheostomy complicated by, 281
tracheotomy anesthesia complicated
by, 25
Portex Blue Line Extra Horizontal Length
tracheostomy tubes, 82– 83
diameters of, 126
Portex Blue Line fenestrated
tracheostomy tubes, 96
Portex Blue Line tracheostomy tubes, 46,
62
diameters of, 125
Portex Blue Line Trach Talk tracheostomy
tubes, 76
diameters of, 133
Portex Blue Line Ultra fenestrated
tracheostomy tubes, 96
diameters of, 127
Portex Blue Line Ultra Suctionaid
tracheostomy tubes, 83
diameters of, 127
Portex Blue Line Ultra tracheostomy
tubes, 63
diameters of, 126
Portex Blue Line Ultra Uncuffed
tracheostomy tubes, 72 –73
Portex Blue Line Uncuffed tracheostomy
tubes, 72
Portex DIC fenestrated tracheostomy
tubes, 95
diameters of, 125
Portex DIC laryngectomy tubes, 89 –90
diameters of, 135
Portex DIC tracheostomy tubes, 51 –52
diameters of, 124
Portex Flex DIC fenestrated tracheostomy
tubes, 95 –96
diameters of, 125
Portex Flex DIC tracheostomy tubes, 52–53
diameters of, 125
Portex Lo-Profile fenestrated
tracheostomy tubes, 96
diameters of, 127
Portex Lo-Profile tracheostomy tubes, 54
diameters of, 127
Portex Mini-Trach II, 101
Portex Per-fit inner cannula, 109
Portex Per-fit tracheostomy tubes, 51
diameters of, 126
Positive end-expiratory pressure (PEEP),
21–22
cuff leaks with high, 167–168
leak speech with added, 199
Positive-pressure ventilation
phonation for patients requiring, 331–335
leak speech with, 332–334
mechanical ventilator adjustment for,
333, 334
tracheostomy tubes characteristics
with, 335
tracheostomy for patients requiring
intermittent, 196 –197
Arcadia CTS with, 197
Bivona TTS with, 197
tracheostomy tube choice with, 117–118
Pressure differences, 12
Project IMPACT, 161
Propofol, 23, 24
Provox LaryTube laryngectomy tubes, 93
diameters of, 135
Pulmonary disease, speaking valves use
contraindicated by severe, 196
Pulmonary edema, postobstructive,
tracheostomy complicated by, 291
Pulmonary function tests (PFT), 22
Pyramidal arytenoids cartilage, 6
Quality of life
laryngectomy with, 273 –274
tracheostomy patient home care with, 345
Railroad method, 149 –150
Recurrent laryngeal nerve (RLN), 6 – 8
Rehabilitation/recovery, 323 –347
acute rehabilitation, 324 –329
airway placement indications in, 325
airway protection need evaluation for,
325 –326
qualifying for, 324
suctioning need evaluation for, 326 –329
tracheostomy tube choice in, 325
adapting tube choice to plans for, 329 –331
bronchial hygiene therapy in, 329 –331
bronchorrhea in, 331
strong cough but poor cough reflex in,
331
clinical follow-up for, 347
Index
359
discharge disposition with, 323 –324
discharge to home in, 339 –340
checklist for, 340
planning for, 340
home care for, 341–347
body image with, 346 –347
caregiver burden with, 345 –346
depression with, 344 –345
emergency care with, 342
Medicare reimbursement with, 342–344
psychosocial costs with, 344 –347
quality of life with, 345
teaching points with, 341
tracheostomy care/supplies with,
341–344
tracheostomy cleaning with, 341–342
phonation for ventilation requiring
patients in, 331–335
leak speech with, 332–334
mechanical ventilator adjustment for,
333, 334
tracheostomy tubes characteristics
with, 335
tracheostomy tube transitioning in,
337–339
cuffless tubes with, 338
downsizing with, 338
fenestrated tubes with, 338
one-way valves with, 338 –339
TTS tubes with, 338
upper airway obstruction relief
evaluation for, 335 –337
soft tissue in, 336
tracheostomy tube in, 336
Respiratory distress, child tracheostomy
with, 253
Respiratory system. See also Airway
pressure differences across, 12
Retained secretions, 163 –164
RLN. See Recurrent laryngeal nerve
Rocuronium, 23
Saline lavage, 226 –227
SCCM. See Society of Critical Care Medicine
Secretions
retained, 163 –164
tracheostomy reasons related to, 309
Secretions, mobilization of, 221–228
airway humidification in, 227–228
mobility in, 228
suctioning for, 221–227
bleeding with, 224
depth of, 224
frequency of, 222
hyperinflation with, 224
open v. closed system of, 224 –225
oxygenation with, 223 –224
saline instillation/lavage with, 226 –227
size of suction catheter with, 222–223
Seldinger technique, 30
Shikani-French valve, 192–194
Shiley cap, 106
Shiley DCT tracheostomy tubes, 49
diameters of, 127, 129
Shiley decannulation plug, 107
Shiley fenestrated tracheostomy tubes, 94– 95
diameters of, 128
Shiley LGT laryngectomy tubes, 89
diameters of, 136
Shiley LPC tracheostomy tubes, 48
Shiley PERC tracheostomy tubes, 50
diameters of, 129
Shiley Phonate Speaking valve, 190, 193
Shiley SCT cuff, 46
Shiley SCT tracheostomy tubes, 61
diameters of, 129
Shiley TracheoSoft XLT tracheostomy
tubes, 80
diameters of, 129
Silicone tracheostomy tubes, cleaning of, 216
Singer laryngectomy tubes, 92
diameters of, 136
Single-cannula cuffed tracheostomy tubes,
61– 69
Arcadia Foam Cuff, 67
Arcadia Silicone Air Cuff, 65
Arcadia Silicone CTS Cuff, 69
Bivona Fome-Cuf, 66 – 67
Bivona Mid-Range Aire-Cuf, 64
Bivona TTS, 68 – 69
Portex Blue Line, 62
Portex Blue Line Ultra, 63
Shiley SCT, 61
Single-cannula cuffless tracheostomy
tubes, 69 –75
Air-Lon Tracheostomy Tube and
Inhalation Set, 70 –71
Arcadia Silicone Cuffless, 74
Bivona Sleep Apnea, 74 –75
Bivona Uncuffed, 70
Moore, 73
Portex Blue Line Ultra Uncuffed, 72–73
Portex Blue Line Uncuffed, 72
TRACOE Comfort, 71
360
Index
Society of Critical Care Medicine (SCCM),
161
Speaking tracheostomy tubes, 334
Speaking valves, 199 –201
airflow with, 189 –190
child tracheostomy with, 259 –261
contraindications for, 260
clinical use of, 193 –196
contraindications for, 196
aspiration risk, 196
hemodynamic instability, 196
pulmonary disease, 196
total laryngectomy, 196
vocal cord paralysis, 196
early piston-type, 190
flap valve, 190
Toremalm valve, 190
effect on aspiration of, 195 –196
Eliachar, 192
Hood, 194
Kisner, 190
Montgomery, 190 –192
Montgomery Ventrach, 192–193
Olympic Trach Talk, 191
Passy-Muir, 191–192
phonation with, 189 –196
secretions decreased with use of, 196
Shikani-French, 192–194
Shiley Phonate, 190, 193
Tucker, 193, 195
types of, 191
Speech. See also Leak speech
after laryngectomy, 270 –272
surgical-prosthetic voice restoration
for, 270 –272
ventilator-dependent patients with,
272–273
Static compliance, 162
Sternal notch, 25
Stomal erosion, 173 –174
external, tracheostomy complicated
by, 288 –289
internal, tracheostomy complicated by, 288
Stomal granulation tissue
management of, 295
prevention of, 295
tracheostomy complicated by, 294 –295
Stoma maintenance devices, 103 –105
tracheal cannula, 104
tracheostomy button and stoma stent,
103 –104
Stoma stent, 103 –105
Stroke, 337
Subcutaneous emphysema, tracheostomy
complicated by, 290
Succinylcholine, 23
Suctioning, 221–227
bleeding with, 224
child tracheostomy, 249 –250
depth of, 224
frequency of, 222
hyperinflation with, 224
open v. closed system of, 224 –225
oxygenation with, 223 –224
patient home care with, 233 –234
rehabilitation need based on evaluation
of, 326 –329
saline instillation/lavage with, 226 –227
size of suction catheter with, 222–223
T-tubes, 231
Supraglottic laryngectomy, 266
swallowing after, 268
Swallowing
airway protection with, 120
after laryngectomy, 268 –270
neural regulation of, 10
phases of, 9 –10
esophageal phase, 10
oral preparatory phase, 9
oral transport phase, 9
pharyngeal phase, 9
physiology of, 9 –10
tracheostomy reasons related
to, 308 –309
ventilator-dependent patient
with, 272–273
Talking tracheostomy tubes, 75 –77
Bivona Fome-Cuf With Talk
Attachment, 77
Blom tracheostomy tube
system, 205 –207
diameters of, 133
Nomori ventilator, 205
phonation with, 203 –207
Portex Blue Line Trach Talk, 76
TRACOE Twist With Air Supply Line, 76
TCF. See Tracheocutaneous fistula
TEF. See Tracheoesophageal fistula
TEP. See Tracheoesophageal puncture
Thyrohyoid ligament, 5
Thyroid cartilage, 5, 10
Index
361
Thyroid gland, 26
Tongue, 3
functional anatomic relevance of, 3
during laryngoscopy, 3
Toremalm valve, 190
Total laryngectomy, 267
speaking valves use contraindicated by,
196
surgical-prosthetic voice restoration for,
270 –272
swallowing after, 268
Trachea, 11–13
tracheostomy button fitting with, 155
Tracheal cannula, 104
Tracheal stenosis
management of, 299
prevention of, 297–299
tracheostomy complicated by, 296 –299
Tracheocutaneous fistula (TCF)
management of, 293 –294
prevention of, 293
tracheostomy complicated by, 293 –294
Tracheoesophageal fistula (TEF)
management of, 293
prevention of, 293
tracheostomy complicated by, 292–293
Tracheoesophageal puncture (TEP),
270 –272
Tracheoinnominate fistula
management of, 292
prevention of, 292
tracheostomy complicated by, 292
Tracheomalacia
cuff leak with, 168 –169
management of, 296
prevention of, 296
repositioning of tracheostomy tubes
with, 118
tracheostomy complicated by, 295 –296
Tracheostomy. See also Complications/
emergency procedures
home care/supplies for, 341–344
cleaning with, 341–342
patients requiring continuous
mechanical ventilation, 197–207
cuffed fenestrated tracheostomy tube
for, 201–203
leak speech for, 198 –201
talking tracheostomy tube for, 203 –207
patients with intermittent positive
pressure ventilation, 196 –197
patients without mechanical ventilation,
183 –196
capping/corking/plugging for, 186 –187
cuffless fenestrated tracheostomy
tube for, 187–189
digital occlusion for, 183 –186
speaking valves for, 189 –196
phonation with, 181–207
methods for, 183
requirements for successful, 182–183
risk of aspiration, 182
reasons for, 307–309
obstruction, 307–308
protection, 308 –309
secretions, 309
swallowing function, 308 –309
ventilation, 307
VOPS acronym, 307
voice restoration with, 181–183
emotional experience of, 182
requirements for, 182–183
risk of aspiration, 182
Tracheostomy button, 103 –105
fitting, 154 –156
length determination for, 154
Olympic, 104
posterior angle of trachea with, 155
purpose of, 154
Tracheostomy patient, 159 –178
care of, 211–236
activities of daily living in, 235 –236
continuous v. intermittent feedings
in, 232
home emergencies in, 234 –235
mobilization of secretions for, 221–228
nutrition in, 232
oral care for, 229
other tracheal appliance care
with, 229 –232
patient at home in, 232–236
tracheal cannula in, 231–232
T-tube in, 229 –231
tube maintenance for, 211–221
cellulitis with, 174 –175
complex wounds with, 173 –175
critically ill patient on mechanical
ventilation as, 160 –163
airway pressures with, 161–162
time to tracheotomy with, 160 –161
work of breathing with, 162–163
cuff changes at altitude with, 169 –172