Covidien Shiley Mode D'emploi page 15

and obturator in an accessible location near the patient should it
be needed in the event of dislodgement.
6. Once the tube is placed in the patient, cuff inflation is under the
discretion of the physician. If cuff inflation is indicated, slowly
inflate the cuff only enough to provide an effective seal. Routine
monitoring of cuff pressure is recommended.
7. Remove the syringe from the valve after cuff inflation.
8. Verify that the cuff inflation system is not leaking. Integrity of the
cuff inflation system should be verified periodically. Any deviation
from the required seal pressure should be investigated and noted.
9. Attach the neck strap to the flange eyelet. Flex the patient's neck
forward and tie the neck strap. When properly adjusted, one finger
space between the neck strap and the patient's neck should exist.
10. Follow current medical accepted procedures regarding the
suctioning to remove secretions.
11. Prior to removing the tube from the patient, deflate the cuff by
inserting a syringe into the valve and slowly removing the air until
a vacuum is noted in the syringe and the pilot balloon is collapsed.
12. Prior to removing the tube from the patient, hold on to the
tracheostomy tube's connector, then gently twist and pull the
attached accessories to disconnect them from the tracheostomy
tube.
13. Remove the tube from the patient following currently accepted
medical techniques.
14. Discard the tracheostomy tube and accessories in accordance with
applicable national regulations.
Adverse Events
Adverse events associated with the use of tracheostomy tubes
during the tracheotomy procedure, during cannulation, or after
decannulation in descending order of severity and frequency are:
obstruction of the tube, accidental decannulation, granuloma, infection,
post-decannulation tracheocutaneous fistula, paratracheal air leak,
stenosis, bleeding, trauma to surrounding tissue, suprastomal collapse,
hyperventilation, hypercarbia, hypoxia, respiratory/cardiac arrest,
toxicity, tracheal fistulas, cough, dysphagia, aspiration, and foreign body
aspiration.
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