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Medical Equipment Problems: Tracheostomies and Gastrostomies

Medical Equipment Problems: Tracheostomies and Gastrostomies. Nightfloat Curriculum 2010-2011 Lucile Packard Children’s Hospital Residency Program. Teaching Goals. Review the critical components of tracheostomy and gastrostomy tubes

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Medical Equipment Problems: Tracheostomies and Gastrostomies

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  1. Medical Equipment Problems:Tracheostomies and Gastrostomies Nightfloat Curriculum 2010-2011 Lucile Packard Children’s Hospital Residency Program

  2. Teaching Goals • Review the critical components of tracheostomy and gastrostomy tubes • Begin initial management of tracheostomy emergencies • Troubleshoot problems with gastrostomy tubes

  3. Obturator and UncuffedTrach

  4. Cuffed Tracheostomy Tube

  5. Bleeding in a Patient with a Tracheostomy: Differential Diagnosis

  6. Desaturation in a Patient with Tracheostomy: Differential Diagnosis

  7. Gastrostomy Tube

  8. Gastrostomy Problems: Tube blockage • Usually clog as a result of medications • Treat with: • Water • Carbonated beverage • Pancreatic enzymes • Replace tube (last resort) • Change to liquid medications, if possible

  9. Tube Displacement • Stoma can close within hours if not held open • Management: Keep site open!!! • Use a foley catheter • After new tube is placed, ensure that it is in the stomach before using • A false passage may be formed between the abdominal wall and stomach, leading to peritonitis. This is especially important in new gastrostomy tubes less than 4 weeks old.

  10. Drainage around Gastrostomy Tube • A small amount of drainage is acceptable. • Keep area dry using nonadherent gauze or foam; do not use occlusive dressings • Ensure no cracks in tubing • Ensure no excessive traction on tube which can stretch the stoma • If drainage persists, may need to upsize tube • In severe cases, may require surgical repair

  11. Redness Around Gastrostomy Site

  12. Gastrostomy Problems: Vomiting • Causes • GERD (may worsen after gastrostomy placement) • Balloon obstructing gastric outlet • Other medical causes • Treat underlying cause

  13. Case # 1 • 8-year-old girl with tracheostomy suddenly desaturates and becomes cyanotic. The first thing you should do is: • Begin chest compressions • Administer 100% oxygen by tracheostomy • Perform needle decompression • Check for tracheostomy tube patency

  14. Case # 1 • 8-year-old girl with tracheostomy suddenly desaturates and becomes cyanotic. The first thing you should do is: • Begin chest compressions • Administer 100% oxygen by tracheostomy • Perform needle decompression • Check for tracheostomy tube patency

  15. Case #2 • 18-month-old boy post-op day 7 after a G-tube and Nissenfundoplication pulls his tube out. All of the following should be performed EXCEPT: • Call surgery • Place a deflated foley in the stoma • Place an NG tube and start pedialyte to maintain hydration • Check new tube placement using a dye study

  16. Case #2 • 18-month-old boy post-op day 7 after a G-tube and Nissenfundoplication pulls his tube out. All of the following should be performed EXCEPT: • Call surgery • Place a deflated foley in the stoma • Place an NG tube and start pedialyte to maintain hydration • Check new tube placement using a dye study

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