Tracoe twist 301-P Instructions D'utilisation page 14

a smaller diameter) to allow the doctor to carry out short-term
ventilation using translaryngeal intubation or a larynx mask.
8.3 Inserting the Tube after Dilation Tracheostomy
The following steps must be carried out by bronchoscopy:
1. Once the tracheostomised patient has been prepared for
cannulation, insert the Seldinger wire and guiding catheter into
the stoma canal. Now push the inserter over the unit (Seldinger
wire/guiding catheter) as far as the safety stop.
2. Make sure that the proximal end of the guiding catheter
always corresponds to the proximal marking of the Seldinger
wire. In this way, the guidewire and guiding catheter will always
precede the inserter.
3. Insert the unit of the recannulation tube or guiding cath-
eter/Seldinger wire and the inserter with the tracheostomy tube
into the trachea, and advance them until the neck flange touches
the skin. We recommend holding the tracheostomy tube and the
inserter together in one hand during insertion.
4. Retract the atraumatic inserter and the recannulation tube
or guiding catheter together with the Seldinger wire, leaving the
tracheostomy tube in place in the trachea. The easiest way of
doing this is to hold the neck flange in place with one hand and
remove the inserter by pushing against the neck flange with the
thumb of the other hand.
5. Then insert the inner cannula. To secure the inner cannula,
hold the neck flange with the fingertips and twist the connector
of the inner cannula until it locks into place, i.e. until the markings
are aligned with each other (C).
When inserting the inner cannula, ensure that the inflation line
(2a) of the cuff is not positioned between the inner and outer can-
nulas, as it may get trapped and damaged.
Make sure that the silicone sleeve is still on the end of the inserter
once it has been pulled out. If not, remove the radiopaque sili-
cone sleeve from the tube or the respiratory tract.
6. For ventilation, connect the standardised 15 mm connec-
tor (3) of the inner cannula to a ventilation machine.
7. Only block the cuff (2) after ventilation via the tracheos-
tomy tube has been established, otherwise there is a risk of as-
phyxiation or emphysema. Inflate the cuff using the pilot balloon
(2a). Now check the cuff pressure to ensure that the cuff has not
been damaged during insertion. Adjust the cuff pressure to the
individual ventilation therapy and check at regular intervals. Typ-
ically, the pressure should be between 20 cmH
and 30 cmH O (≈ 22 mmHg).
2
Attaching a hand-held manometer causes a fall in cuff pressure.
O (≈ 15 mmHg)
2
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