COOK Medical Ciaglia Blue Rhino G2, Инструкция по эксплуатации

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5. Prep and drape the anterior neck area.
6. Generously lubricate the surface of the appropriately sized loading
dilator and load the tracheostomy tube onto the dilator. Ensure that the
tracheostomy tube’s tip fits snugly on the dilator. (Fig. 2) Ensure that the
balloon is completely deflated. Thoroughly lubricate tracheostomy tube
assembly.
Tracheostomy Procedure
NOTE: Dual cannula tracheostomy tubes may also be placed using the
following technique. The inner cannula must be removed for introduction.
Always check the fit of the dilator to the tracheostomy tube prior to insertion.
1. Palpate landmark structures (thyroid notch, cricoid cartilage) to
ascertain proper location for tracheostomy tube placement. Access and,
ultimately, tube placement is ideally made at the level between the
first and second tracheal cartilages or between the second and third
tracheal cartilages whenever feasible. (Fig. 3)
2. After introducing local anesthesia, make a 1.5-2.0 cm skin incision
(vertical or horizontal) at the chosen insertion site. (Fig. 5)
3. If desired, use a curved mosquito clamp to gently dissect vertically
and transversely down to the anterior tracheal wall. (Fig. 6) With a
fingertip, dissect the front of the trachea, in the midline, free of any
tissues and identify the cricoid cartilage. Displace the isthmus of the
thyroid downward, if present. NOTE: an adequate skin incision and
blunt dissection of the subcutaneous tissue can minimize the need for
excessive force and torque throughout the procedure. Excessive force and
rotation may lead to long-term complications (e.g., stenosis).
4. Deflate the endotracheal tube cuff and withdraw to an appropriate
distance above the insertion site, yet still within the trachea. Re-inflate the
cuff once the proper position of the endotracheal tube has been reached.
5. Attach a syringe half-filled with fluid to the introducer needle and seek
the tracheal air column by directing the needle, in the midline, posterior.
Verify entrance into the tracheal lumen via aspiration on the
syringe resulting in air bubble return. (Fig. 7) Alternatively, if using
bronchoscopy, visualize the needle entering the trachea.
NOTE: It is important that the needle not impale the endotracheal
tube. To ensure that the endotracheal tube is not impaled, gently
move it in and out 1 cm. If the tube is impaled, the needle will be
seen and felt to also move. If this occurs, it will be necessary to
withdraw the needle, pull back the endotracheal tube, and then
reinsert the needle. NOTE: Proper positioning and alignment may help
minimize complications (e.g., stenosis).
6. With the needle tip positioned in the trachea, local anesthesia may be
injected (if necessary).
7. When free flow of air is obtained, with no impalement of the endotracheal
tube, remove the inner needle of the introducer needle assembly and
advance the outer FEP sheath several millimeters. NOTE: If using an
introducer needle without a sheath, proceed to step 9.
8. Attach a syringe to the FEP sheath and re-confirm position within the
tracheal lumen by visualizing free flow of air into the syringe when
aspirated. (Fig. 8) Alternatively, re-confirm position by visualizing the FEP
sheath in the trachea with the bronchoscope. Remove the syringe.