Tracoe 450-P Instrucciones De Uso página 34

scale on the tube faces upwards (cranial) with the distal end of the tube oriented caudal. The
information engraved on the neck flange has to be readable (TRACOE logo towards patient's
chin; see Image 2).
6. Check the rotating function of the neck-flange wings and place both wings in a position that will
be most comfortable for the patient.
7. Check if the pre-assembled silicone sleeve smoothly bridges the gap between the conical end
of the inserter and the distal end of the tube. If a gap is visible, the connection can be tightened by
carefully rotating the handle of the inserter.
8. Check if the Seldinger wire (not included), fits smoothly inside the guiding catheter of the mini-
mally traumatic inserter.
9. The silicone sleeve and the end of the tracheostomy tube are then lubricated with the lubricant
gel supplied.
10. If appropriate, the neck strap can be attached to the neck flange wings for fixation after insertion
of the tube.
B. When using the obturator for re-insertion
Follow steps 1 – 6 as described above and proceed as follows:
11. Ensure the obturator inside the tracheostomy tube can be easily moved in and out of the tube.
12. Ensure a suction catheter can be easily inserted through the tube.
13. Place the obturator inside the tracheostomy tube.
14. Apply a thin film of lubricant gel to the protruding part of the obturator at the lower part of the
tube including the cuff.
15. If appropriate, the neck strap can be attached to the neck flange wings for fixation after inser-
tion of the tube.
8.2 Preparing the Patient
Ensure that the patient is optimally pre-oxygenated immediately before insertion or re-insertion.
To facilitate insertion, slightly overextend the patient's neck, if possible.
8.3 Inserting the Tube
A. With the Minimally Traumatic Insertion System
For initial insertion following tracheostomy, the following steps must be carried out subject to
bronchoscopic monitoring:
1. The tracheotomised patient has been prepared for cannulation and a Seldinger wire has been
inserted into the stoma canal.
2. Insert the proximal end of the Seldinger wire into the distal end of the guiding catheter without
pulling the Seldinger Wire out of the trachea.
3. If using the TRACOE percutan Seldinger Wire place the proximal end of the guiding catheter at
the marking on the Seldinger wire.
4. Insert the tube together with inserter and Seldinger wire through the tracheostoma into the
trachea. Take care that the tube, inserter handle, guiding catheter, and Seldinger wire remain
aligned and fixed with one hand. Any displacement may result in a gap between the silicone sleeve
and tube and resulting in a difficult or aborted insertion.
5. Gently push the tube forward until the neck flange is in contact with the skin surface.
6. Once in place, secure the tube with one hand and withdraw the inserter and guiding catheter
together with the Seldinger wire while the tracheostomy tube remains in position within the trachea.
Caution:
• After removing the inserter, ensure that the silicone sleeve is still located on the guiding
catheter. If this is not the case, the silicone sleeve (radiopaque) must immediately be removed from
the tube or airway.
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