Fahl SPIRAFLEX, Инструкция по эксплуатации

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EN
Make sure that the tube is not damaged by friction when using an instrument for assistance.
Now carefully insert the tube into the tracheostoma during the inspiration phase (while breathing
in) while tilting your head slightly back (see picture 7).
Advance the tube into the trachea.
Straighten your head once the tube has been inserted further into the trachea.
Once the tube has been brought into the correct position in the trachea, remove the obturator
and tighten the locking screw.
The tracheostomy tubes should always be attached with a special tube holder. This stabilises
the tube and thus ensures that the tracheostomy tube is securely seated in the tracheostoma
(see picture 1).
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
15 mmHg (20 cmH2O) to 18mmHg (25 cmH2O). The cuff pressure should never under any
circumstances exceed 18mmHg (approx. 25 cmH2O).
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 res -
piration, 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 noi -
ses 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 perme -
ability 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 anaes -
thesia. 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.
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 can be
used for temporarily securing the air supply.