Teleflex TracheoFlex RUSCH Mode D'emploi page 6

To avoid irritation of the skin in the area of the fixation flange, especially
in the case of a wet tracheostoma, it is obligatory to place a commercially
available slitted compress between the skin and the fixation flange.
When using cannulas with cuff:
For safety reasons, the tracheostomy tube should be fixed before
the cuff is inflated, if it is introduced by the patient himself or
by auxiliary medical staff.
Caution:
• Avoid exerting high tensile forces on the trachea through the
ventilation tubing and the connector on the tube shaft.
Warning! Danger of extubation!
• Avoid all alcoholic disinfectants when looking after the tracheostoma.
• Never wet the slitted compress with disinfectants containing alcohol!
6.
Inflating the cuff (Cuff related!)
The cuff of this tracheostomy tube set may only be inflated intermittently
or for a short time (e.g. during eating) in order to avoid damage to the
tracheal mucosa. To inflate the cuff, use a syringe to inject air into the
filling system through the valve. The amount of air should be just
sufficient to seal the trachea (minimum inflation volume). If ventilation
gases still escape between the cuff and tracheal wall during active
ventilation, the minimum inflation volume of the cuff has not yet been
achieved. In this case the user or patient helper can hear a hissing
noise using a stethoscope or with the ear at the patient's mouth or
stoma.
Air is then carefully added to the filling system until the hissing noise
can no longer be heard during the inhalation phase.
It should be noted that the cuff should not be filled with more than
the minimum inflation volume of air. Otherwise the proportion of cuff
pressure which is passed on to the mucosa is too high, mucosal
circulation at the contact point with the cuff can be impaired and
major sequelae can be expected in the long term.
Caution:
If the trachea cannot be sealed off despite reaching the maximum filling
volume, the entire filling volume should be removed from the cuff and a
renewed filling and inflation attempt should be made. If this is again not
successful, the next largest tracheostomy cannula should be selected.
Warning:
• Anaesthetic gases administered via the tracheostomy tube may lead
to gas diffusion with a pressure increase in the cuff system. As the
actual pressure on the mucosa exerted by the inflated cuff cannot be
established by direct pressure monitoring, the cuff should only be
inflated intermittently or for a short time. (The intervals between
inflations should be determined by the physician.)
• At all costs, avoid closing the machine end of the tube with a
phonation valve or sealing plug or similar when the cuff is inflated.
Even with an empty cuff, connecting a phonation valve may some-
times lead to considerable difficulty in respiration (dyspnoea).
Closing the tube (with an empty cuff), e.g. with a plug to wean the
patient off the tube, may only be performed under medical super-
vision and responsibility.
If the desired inflation has been achieved, the syringe should be
removed from the valve.