Fahl Duratwix Mode D'emploi page 25

If you are inserting the tube yourself, use a mirror to make insertion of the Fahl tracheostomy
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tube easier.
When inserting the Fahl tracheostomy tube, hold it by the neck flange with one hand (see
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EN
picture 5).
Pull the tracheostoma slightly apart with your free hand to allow the tip of the tube to fit into
the tracheostoma more easily.
Special aids for dilating the tracheostoma are also available (tracheal dilator, REF 35500).
These allow the tracheostoma to be dilated gently and evenly, for instance also in emergency
situations with collapsing tracheostoma (see picture 6).
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.
If an obturator is used, this must then immediately be removed from the tracheostomy tube.
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).
1.9 Inflating the low-pressure cuff (if present)
The low-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 cuff
pressure gauge (e.g. MUCOPROTECT , REF 19500). If not instructed otherwise by the
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doctor/physician, we recommend a cuff pressure of at least 15 mm Hg (20 cm H2O) to 22
mm Hg (30 cm H2O). The cuff pressure should never under any circumstances exceed 22
mm Hg (approx. 30 cm H2O).
Inflate the low pressure 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 low-pressure cuff is undamaged and in perfect working order.
If the desired sealing is not achieved even after trying repeatedly 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 and close the connection with the cap.
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 low pressure cuff
with subsequent deflation, or distortion 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).
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