Stomas Ostomies and

Home Ventilators

By Wesley Rolfson

Tracheostomies

• “Tracheostomy is an operative procedure that creates a surgical airway in the cervical trachea”1– Often performed for long term ventilation– Inner and outer cannulas– Some have cuffs

• Endotrachial tubes cause damage to:– Vocal cords– Trachial tissue

1. Jonathan P Lindman, MD Tracheostomy, eMedicine, http://www.emedicine.com/ent/TOPIC356.HTM, 2006

Tracheostomies

• Common Indications– Obstructions– Facial or Neck trauma– Subcutaneous emphysema – Edema – Long Term mechanical ventilation– Chronic Aspiration issues– Preparation for extensive facial or neck surgery– Sleep apnea not treatable by a less invasive

procedure

Tracheostomies

• They are prone to respiratory infections

• Stenosis of tissue around trach tube

• Erosion of trachea into the esophagus

• Granuloma– Growth of inflammatory tissue in or around the

trachea

Tracheostomies and EMS

– Caregiver or patient is calling because

• Cannula is displaced• Something is obstructing the

cannula• Issues with a ventilator• Respiratory infection/ congestion• Bleeding

– Recent tracheostomies are high risk patients

• Stoma• Education issues

Treating their Trach.

• History– Last time changed– Recent illness– Prior trach issues– Native airway?– Past Medical history

• Breathing– Position Patient– Cough– Suction– Ventilate patient

Treating their Trach.

Cannula/Obstruction– Cough– Suction– Remove cannula– Entubation

• Remember– Native airway may still

function– You can disconnect

the ventilator as long as you can breath for them

Entubating a Stoma

• ****Check with local ****Check with local protocols****protocols****

• Deflate the cuff • Remove the cannula• Place ET tube 1-2 cm through

stoma• Inflate cuff until no air is

escaping– Do not over inflate

• Check for placement using standard methods

• Secure tube using tape

Home Ventilators

• Used for patients – Post surgery– Sleep apnea– Neuromuscular conditions

• Quadroplegia, muscle weakness, Polio

– Parenchymal lung diseases• COPD, pneumonia, fibrosis, rheumatoid arthritis,

Lupus, sarcoidosis

Types of Ventilators

Ventilators

• Common issues– Mechanical failure– Improper use or training– Change in patient condition– Tubing disconnected or obstructed

Ventilators and EMS

• ****Follow local Protocols********Follow local Protocols****

• Repostion patient

• Suction airway

• Reconnect tubing

• Take over breathing for patient if needed

• Get a good history and record information about ventilator (flow and rate)

Ostomies

• Any Surgery that produces a stoma, specifically surgeries that divert the Intestines, Colon or Ureters. – Colonostomy, Ileostomy, Urostomy

• Common reasons for Ostomies– Cancer, Diverticulitis, Crohn’s Disease,

trauma, neurological diseases, genetic defects

Ostomies

Ostomies

• Should have an ostomy bag in place

• Depending on location of ostomy may produce liquid or solid fecal matter

• Digestive enzymes may corrode skin around stoma

• Ostomy site should be pink or red

• Most pouches can be emptied without removal

Ostomies and EMS

• Common complaints are Cramps, constipation, pain, diarrhea, bleeding, tearing, excess gas

• Check for skin and systemic infections• Assist in emptying ostomy bag as needed• Apply a sterile dressing if no ostomy bag found• Avoid puncturing ostomy bag

– Contents should be considered caustic

Bibliography• A K Simmonds Risk management of the home ventilator dependent patient, Thorax, 2006; 61

369-371• Cynthia Bissell, Aaron’s Tracheostomy Page, Tracheostomy Complications

http://www.tracheostomy.com/care/complications/index.htm updated 05/14/07• Gary D. Vogin, MD Living with a Colostomy, The Cleveland Clinic 2001• Jan Clark, RNET, CWOCN, Peg Grover, RNET, COLOSTOMY GUIDE, 2004• Jonathan P Lindman, MD Tracheostomy, eMedicine,

http://www.emedicine.com/ent/TOPIC356.HTM, 2006• John Nozum, Sleep Apnea: Frequently Asked Questions, http://

home.att.net/~jnozum/Trach/FAQ.htm , 2006• John Prestwich 'I lived in an iron lung for seven years' Technology, November 14th 2005• Richard Robinson, Breathe Easy Options Offered for Respiratory Care ,QUEST, MDA

Publications, October 1998, Vol 5 no. 5• Robert S. Porter, M.A., Bryan Bledsoe, D.O., Richard Cherry, M.S. Paramedic Care Principles

and Practice Special Considerations Operations, second edition, Brady, Prentice Hall Health, Upper Saddle River, NJ, 2006 p 1:597-600 5:130-131, 5:271-276

• Sharon Doty, Tanya White, Victor Segura Frequency, Causes, and Outcome of Home Ventilator Failure, Chest 1998; 114; 1363-1367

• UW Department of Surgery, Ostomy Care Service http://depts.washington.edu/ostomy/colo-ileo.html, © 2004.