What kind of atomizer is more suitable for tracheotomy patients?

(a) postoperative care 1, put the patient in a quiet, clean room with fresh air, keep the room temperature at 2 1℃, keep the humidity at 60%, cover the tracheal cuff with 2-4 layers of warm and wet gauze, sprinkle water frequently indoors, or use a humidifier to disinfect the indoor air regularly with ultraviolet rays. 2. At the beginning of the operation, the patient usually takes a lateral position to facilitate the discharge of tracheal secretions. However, it is necessary to rotate the body position frequently to prevent bedsores and respiratory movement stagnation in various parts of the lungs. 3. Prepare first-aid medicines and articles, some of which should be placed at the bedside. The same number of endotracheal tubes, tracheal dilators, surgical scissors, hemostatic forceps, dressing changing appliances and dressings, physiological saline and saturated sodium bicarbonate solution, urethral catheterization bags, aspirators, inflators, ventilators, flashlights, etc. It should be prepared and kept in case of emergency. 4. Beware of tracheal catheter blockage: the first reason for blockage is that the balloon slips and blocks, and the second is that the secretion sticks to scab and blocks. When dyspnea, cyanosis and patient's irritability suddenly occur, the intubation balloon should be taken out immediately for examination. In order to prevent the airbag from slipping off, we should pay attention to tying the airbag tightly, leading the thread out of the tracheotomy wound, and regularly checking whether it is firm and removing scabs in time. In addition, when replacing the catheter for cleaning and disinfection, prevent the cotton ball yarn from staying in the catheter. 5. Suction of sputum in time: Patients with tracheotomy have difficulty in coughing and expectoration, so they should clear the sputum in the airway at any time, strictly abide by the operating procedures and pay attention to aseptic observation. 6, full humidification: tracheotomy patients lose the humidification function, prone to airway obstruction, atelectasis, secondary infection and other complications. The following methods are commonly used for humidification: (1) intermittent humidification: add 500ml of normal saline and 120000 units of gentamicin, and slowly inject 2-5ml into the trachea after each sputum aspiration, with a total amount of about 200ml per day, or intermittently use steam inhalers and atomizers for humidification; (2) Continuous humidification method: the humidification liquid is slowly dripped into the trachea through the scalp needle in the form of infusion, and the dripping speed is controlled at 4-6 drops per minute, and it is not less than 200ml every day and night. Antibiotics or other drugs can be added to the humidifying solution as needed. 7. Prevention of local infection: Take out the endotracheal tube every time and clean and disinfect it for 2-3 times. Generally, the external tube can be removed for replacement and disinfection after the sinus is formed in the tracheal incision 1 week after operation. The gauze of endotracheal tube should be kept clean and dry and replaced daily. Always check the skin around the wound for infection or eczema. The catheter is first soaked in 0.5% bromogeramine, then boiled and disinfected, and then washed and boiled with clear water before use. The serpentine tube is soaked in 0.5% bromogeramine and replaced every day. 8. Care for the patient and give spiritual comfort: After tracheotomy, the patient can't pronounce. Written conversation or action can be used to prevent the patient from pulling out the cannula because of impatience, and try to fix his hands when necessary.

(2) Common complications of tracheotomy 1, catheter shedding: often caused by unstable fixation. Managing the detachment is a very urgent and serious situation. If it is not treated in time, it will soon suffocate and stop breathing. 2, bleeding: can be caused by incomplete hemostasis during tracheotomy, or catheter compression, stimulation, rough sputum suction and other injuries to the tracheal wall. The patient feels pain in the sternum stalk or blood in the sputum. In case of massive bleeding, endotracheal intubation should be performed immediately to stop bleeding. 3. Subcutaneous emphysema: It is a common complication of tracheotomy. Emphysema mostly occurs in the neck and occasionally spreads to the chest and head. When subcutaneous emphysema is found, nail purple can be used to mark the edge of emphysema and observe the progress. 4. Infection: It is also a common complication of tracheotomy. It is related to the disinfection of indoor air, the pollution of sputum suction operation and the original situation. 5. perforation of tracheal wall ulcer: improper intubation after tracheotomy, or prolonged intubation, deflation and decompression when the balloon is uncertain, etc. Will lead to it. 6. subglottic granuloma, scar and stenosis: late complications of tracheotomy.

(3) Precautions in sputum aspiration 1. Sputum aspiration should be gentle and rapid to reduce the damage to the tracheal wall. Generally speaking, rubber or silicone catheter. 12 or no. Choose 14 with moderate hardness, smooth surface and relatively large inner diameter, or adopt autocratic sputum suction tube, or cut off the thick blind end at the front end of the catheter to make it concave crescent-shaped, and then cut two small holes on both sides to reduce the negative pressure at the head end and increase the sputum suction area. If the patient feels pain in the sternal stalk and there is blood in the sputum, he should be alert to the possibility of bleeding. In case of massive bleeding, rescue measures such as tracheal intubation and hemostasis should be implemented immediately. 2, pay attention to aseptic operation when sputum suction, wash your hands before operation, catheter strict disinfection, a catheter only once, adhere to the principle of from the inside out when sputum suction, first the secretions in the straw, then the nasal cavity and oral cavity secretions. 3. Take a deep breath 3-5 times before sputum aspiration. The user of the ventilator needs to hyperventilate for 2-3 minutes to increase the oxygen partial pressure in the alveoli, and then suck out the secretion quickly, accurately and gently with the sputum suction tube. It is forbidden to insert sputum tubes up and down. Sputum aspiration time is less than 15 seconds, especially in patients with respiratory failure. Long-term negative pressure suction can cause hypoxia, dyspnea and asphyxia. If there is too much secretion, it can't be sucked clean at one time, so hyperventilate or inhale again. 4. Before starting the aspirator, the suction tube must reach the depth of the trachea, or when starting the aspirator, fold the suction tube and the glass joint by hand to prevent leakage, and then extend the suction tube into the trachea to a certain depth before loosening the suction tube. 5. The suitable suction negative pressure is 6.7 kPa (50 mm Hg). 6. When sputum is sucked, patients often have cough reflex, which is beneficial to expectoration and sputum suction.

(4) Nursing of extubation Only when the extubation condition is stable, the respiratory muscle function is restored, the cough is strong, the sputum can be discharged by itself, and the dependence on tracheotomy can be relieved can the blockage test be carried out. When plugging pipes, 1/3 is blocked on the first day, 1/2 on the second day and completely blocked on the third day. If there is no dyspnea after 24-48 hours of occlusion, and you can sleep, eat and cough, you can extubate. Disinfect the fistula with 75% alcohol after extubation, and wrap it with butterfly tape for 2-3 days to heal. If it doesn't heal well, it can be stitched. Early extubation can reduce the occurrence of complications such as tracheal infection and ulcer.