Covidien Shiley 4CN65A Mode D'emploi page 6

nula; 1 obturator; 1 neck strap. Reference page 2 for sizes and dimensions.
accessories available from covidien: CAP, Disposable Inner Cannula (reference 10006780 for part
numbers).
accessories available separately: Some of the tube sizes (reference page 2) are compatible with
the Percutaneous Dilatational Loading Dilator from the COOK® Critical Care Ciaglia Percutaneous
Introducer Sets and Trays.
note: The sizing dimensions listed on page 2 refer to the ID (the inside diameter of the tube or inner
cannula at its narrowest point), the OD (the outside diameter of the tube, not including cuff features), and
the length (the distance from the neck plate to the distal tip on the tube's or inner cannula's centerline).
tube Preparation and cuff Inflation test
1. Based on the physician's discretion, select the appropriate tracheostomy tube size.
2. Test the cuff and inflation system for leakage before inserting the tube, as follows:
a. Inflate the cuff with the volume of air indicated on page 2.
b. Either observe for deflation over several minutes, or immerse the tube in sterile saline and
observe for air leakage.
c. Deflate the cuff before insertion.
tube Insertion Using the obturator or a Percutaneous Loading Dilator
The tube sizes that have a compatible loading dilator available (reference page 2) can be used in
percutaneous dilatational tracheotomy (PDT) procedures.
note: As this tracheostomy tube can be placed percutaneously, sterile technique should be fol-
lowed for the handling and placement of the tracheostomy tube.
1. To ease insertion and to guard against cuff perforation from sharp edges of cartilage, taper back
the cuff as follows:
a. Deflate the cuff.
b. Gently move the cuff away from the distal tip of the tracheostomy tube toward the neck plate
as the residual air is removed by deflation.
2. Insert the obturator or compatible loading dilator into the tracheostomy tube.
• If using the obturator, ensure it is fully seated. If indicated to ease insertion, apply a thin film
of water soluble lubricant to the outside of the tracheostomy tube, cuff, and protruding por-
tion of the obturator.
• If using a loading dilator for a PDt procedure, generously lubricate the surface of the ap-
propriately sized loading dilator and load the tracheostomy tube onto the dilator. Ensure that
the tapered section of the loading dilator clears the distal tip of the tracheostomy tube by
approximately 2 cm.
note: The loading dilator is available separately.
3. If using a guide wire with the obturator, first insert the guide wire in the patient, then thread it all
the way through the obturator, starting at the distal tip of the obturator.
warnIng
If the guide wire is damaged during the procedure, it may be difficult to continue insertion with-
out trauma to the trachea and misplacement of the tracheostomy tube. In these cases, it may be
possible to continue only if:
a. the damaged section can be advanced into the trachea, and
b. there is a sufficient length of undamaged guide wire remaining.
If the guide wire cannot be salvaged, use a new guide wire.
4. Insert the tube into the patient's trachea.
5. After the tube is properly in place, remove the loading dilator or obturator and guide wire (if
used) immediately.
6. Insert the disposable inner cannula into the tracheostomy tube and press to lock into position.
7. Clean the obturator and store it in an accessible location near the patient in case it is needed for
an unscheduled re-insertion.
cuff Inflation
1. Inflate the cuff only with enough gas mixture to provide an effective seal at the desired lung
inflation pressure. Use Minimal Occluding Volume or Minimum Leak techniques in conjunction
with an intracuff pressure measuring device in selecting the sealing pressure.
2. Secure the tracheostomy tube to the patient using the neck strap provided.
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