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
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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
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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
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Last time changed
Recent illness
Prior trach issues
Native airway?
Past Medical history
• Breathing
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Position Patient
Cough
Suction
Ventilate patient
Treating their Trach.
Cannula/Obstruction
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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
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
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****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
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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
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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/coloileo.html, © 2004.