Fahl TRACHEOSILC Manual Del Usuario página 17

1.1 Inflating the cuff (if such exists)
The 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. If not instructed otherwise
by the doctor/physician, we recommend a cuff pressure of at least 18 mmHg (20 cmH2O) to 22mmHg
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(25 cmH2O).
The high-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 syringe.
Inflate the 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 cuff is undamaged and is functioning faultlessly.
If the desired sealing is not achieved even after repeated attempts 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.
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physician, the entire air should be withdrawn again from the balloon and the sealing process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 cuff with subsequent deflation, or
deformation 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 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.
Then deflate the cuff while suctioning at same time. If secretions are present, these are
now removed and can no longer be aspirated. Please note that prior to reinsertion, the
tracheostomy tube must always be cleaned, disinfected if necessary and lubricated with stoma
oil as specified below.
Proceed very carefully to avoid injury to the mucus membranes.
Step-by-step instructions to remove the Fahl tracheostomy tubes:
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