Presentation13&14

8/8/2019 Presentation13&14

1/17

Group D

Aine Hamilton

Karen Jones

Kathryn Kavanagh

Serena Keary

Grainne Kelly

Eilish LeahyClaire A. Lennon


2/17

Summaryy This article discusses Iatrogenic Tracheal Trauma which is a

condition caused by veterinary staff that leads to tracheal damage

and tears, that cause pain and discomfort to patients.

Common causes being incorrect use of ET tubes;

y such as insufficient or inappropriate cleaning methods

y incorrect tube choice

y poor tube insertions

y

over inflation of cuffsy excessive movement of patient

y incorrect anaesthetic equipment choice i.e. undersized breathing

bags, high oxygen flow rates and closed pop off valves.


3/17

Summary Condt.Various common clinical signs:

y dyspnoea ( difficulty breathing)

y Coughing

Diagnosis :

y Radiography

y Tracheoscopy or surgery leads to definitive diagnosis.

y Close attention in extubating post anaesthesia ensuring the ability to swallow isregained and preventing dysphoria both which cause endotracheal trauma.

y Treatment of tears depends on severity and location of damage, painmanagement being of primary importance, and emphasis on rest to promotehealing.

y Veterinary nurses play a key role in preventing complications by understandingthe problems that can arise and in correct monitoring and management of

intubated patients to ensure patient safety.


4/17

What is the source material?

JAVMA:

y which stands for theJournal of American Veterinary MedicalAssociation, is produced by the American Veterinary MedicalAssociation and is a major source with regard to this

particular article.y The AVMA is an association that is highly regarded in the

veterinary medicine profession and this shows as it has beenin operation since 1863.

y

The journal began publication in the 1880s and since then ithas been the voice of well established veterinary practitionersas they submit results of clinical studies and research.

y Therefore this source of information could be deemed asbeing very accurate and trustworthy.


5/17

Atlantic Coast Veterinary Conference:

y The intention of this yearly conference is to promote new

techniques in the veterinary field.

y It involves a group of veterinary professionals who are

regarded very highly in their field of work, presenting

different seminars about a wide range of advancements in

veterinary, therefore the information obtained from thisconference is of high quality and very precise.

What is the source material?


6/17

What are the authors credentials?Ronald E. Whitford

y has been in private practice for 38 years and is owner/chief of staffof 3 full-time service veterinary hospitals.

y He has contributed to Blackwells five-minute veterinarymanagement consultation which is a book that was published in2007.

y He is a nationally recognised speaker, writer and consultant withinthe veterinary profession in America.

y He has published over 250 articles on Veterinary PracticeMarketing and Management

y He was a speaker at the 2010 Atlantic Coast Veterinary Conference,which is only open for very knowledgeable and experienced

veterinary professionals.y He is a memebr of PetCareTVs Veterinary Advisory Board(VAB)

which is comprised of respected practitioners, hospital owners andleading professsional consultants from around the world.

y Because of his involvement with a vast amount of veterinaryassociations, he is a well educated and respected veterinaryprofessional who is definitely within capability of discussing this

topic.


7/17

Why was the material written?y -The main objective of the material is to give veterinary

professionals the essential information regarding iatrogenictracheal trauma in order for them to take the necessaryprecautions and measures so as to avoid it from occuring in theirpatients.

y -A major reason why the material was written is to giveprofessionals understanding of the endotracheal equipment usede.g. tubes and to identify any drawbacks the equipment mighthave.

y -The material further educates veterinary professionals on all

aspects regarding iatrogenic Tracheal Trauma, by identifying thepossible causes of it, steps that should be taken to prevent it andpossible treatment methods of the patient should tracheal traumaoccur.


8/17

Is the author biased?y

The author cannot be looked upon as being exceedingly biased inthe portrayal of his article.

y He only once gives his own opinion when he shows preference toethylene oxide for sterilising ET tubes, he thinks it is of

better standard compared to others.

y However he does state that this it is his opinion and does not try topersuade his readers to use this individual drug or doesnt showprejudice towards other drugs.

y In general, the author simply provides information on the subjectof iatrogenic Tracheal Trauma without trying to persuade hisreaders to believe in any particular theory or idea.


9/17

y However he can be looked upon as being biased with regardto the specific sources from where he obtains hisinformation.

y He obtained information from the Atlantic Coast VeterinaryConference of which he has involvement in as he presentsseminars at them.

y He also uses information from articles published by theJAVMA, which he is also engaged in as he occasionally writesarticles for them.

Is the author biased?


10/17

Does the author make assumptions?

y The writer doesnt make assumptions throughout his article,

rather he uses information from his references to reinforce

any points or principles that he outlines.

y If it appears that he does make assumptions it is for a good

reason as he is stressing to the reader that an experienced

person should only carry out tracheal tube insertion on their

own as there is less risk of damaging the trachea


11/17

Does this article contains information

that is useful in a practice situation?

y Yes I think this information is extremely useful in a practice

situation.

yIatrogenesis (where the patient is harmed by the veterinarystaff) causes unnecessary pain, profit loss, poor staff morale

and the client may lose trust in the practice.

y It may also mean further invasive and painful procedures to

an already ill animal.


12/17

Outlinehow you could apply this

information in practice?

Know what causes Iatrogenic Tracheal Trauma:

y Too large an ET tube ( causing damage to the cartilage)

y Too small a tube (needs to much cuff inflation)y Stylets that protrude past the ET tube while incubation

occurs

y Placement of ET tube past tracheal bifurcation

y Inflated cuff extubation

y Incorrect patient handling while incubated

y Incorrect disinfection of the ET tube (leading to perhaps

chemical burns in the next patient)


13/17

Know the signs of Iatrogenic Tracheal Trauma:

Immediately after tube extubation:

y Coughing

y Gagging

y Difficulty swallowing

Can manifest hours of days after:y Subcutaneous emphysema (Air in the subcutaneous

tissue)

y Dehydration

yTachycardia

y Tachypnea,

y Dyspnoea,

y Ptyalism (drooling)

y

Pyrexia


14/17

Know correct cleaning methods of ET tubes:

y Wash in water first to remove mucous and other debris.

y Soak in disinfectanty Wash thoroughly to avoid giving the next patient a chemical burn

from the disinfectant

Proper Insertion and management of ET tubes:y Proper lighting

y Secure the tube to prevent it kinking or moving from desiredposition

yProper cuff inflation

y On removal: deflate the cuff at the right time while the patient isrecovering from the anaesthesia, the patient should be able toswallow to prevent aspiration of any debris in the oral cavity.


15/17

y Any of this information could be, and should be used inpractise.

y Professional techniques should be conducted from theveterinary surgeon in relation to techniques in

intubation, cuff inflation and ET tube sizing.y While proper cleaning should be carried out by the

nursing staff along with assistance in proper patienthandling.

yIf proper protocol is followed, tracheal trauma to thepatient will be eliminated and client satisfaction will beupheld.

Outlinehow you could apply this

information in practice? Condt.


16/17

References

y Whitford,R.E.& Johnsen,K.Preventing Iatrogenic Tracheal

Trauma.Veterinary Technician July 2007(Vol28,No.7)

y www.avma.com

y

www.acvc.orgy www.stbethlehemsmallanimalclinic.com


17/17

Any Questions ?

Documents

Presentation13&14