Trach Care-Cleaning - Suction Catheters, Brushes

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Tracheal Care / Cleaning

Criticalcare

PREPARE YOURSELF TO HANDLE THIS SUDDEN, DRAMATIC BLEEDING.

Patients who've had neck surgery or who have an invasive tumor involving the carotid artery are at risk for carotid artery rupture, a rare but dramatic and lifethreatening complication that often occurs without warning. Spontaneous carotid artery rupture is fatal in up to 50% of cases. Patients who survive credit bedside nurses for the initial control of hemorrhage.

Are you prepared to deal with a carotid artery rupture? Can you prepare the family and friends of a palliative care patient who may experience this event at home? In this article, I'll describe who's at risk and how to handle this emergency in the hospital or in the patient's home.

Who's at risk?

Carotid artery rupture occurs in up to 4% of patients who've had neck surgery, especially if tracheal or pharyngeal secretions drained into the operative site during surgery. Infection, fistula formation, or skin necrosis that exposes the carotid artery can also lead to rupture. Patients over age 50 who've recently lost 10% to 15% of their usual body weight are at increased risk too. The typical patient experiencing this complication is malnourished, anemic, and hypovolemic.

Preoperative or intraoperative radiation therapy also significantly increases risk because it reduces regional blood supply, impairs lymph drainage, and impedes tissue healing.

Now arteries erode

Muscle flaps and dermal grafts can be used to protect the carotid artery after neck surgery. However, these measures may fail, and in any case where progressive tissue breakdown exposes the carotid artery, covering the artery quickly is crucial to preventing rupture. The adventitia, or outermost layer of an artery wall, is susceptible to drying and infection if it's exposed to the atmosphere. This connective tissue layer carries 80% of the blood supply to the remaining two arterial layers. When the adventitia is exposed to the atmosphere, the drying process destroys the blood supply, leading to cell breakdown and the beginning of arterial erosion or lamination, or layer-by-layer tissue loss. Eschar sloughs off or is removed during wound cleaning, exposing the middle or medial arterial layer and subjecting it to the same drying and sloughing process.

Eventually the fragile intima is the only tissue layer remaining. The constant pulsation of blood in the artery thins this layer until you may be able to see blood surging through the vessel.

Without treatment, an artery can erode to the point of rupture in 6 to 10 days. Early reconstruction with a vascularized flap can cover the carotid artery and prevent erosion.

What happens

Ruptures can occur in several places. The common carotid artery, which branches into the internal and external carotid arteries, is the more common site, but ruptures can occur elsewhere.

If the rapture is in the internal carotid artery, which has anastomoses with the opposite internal carotid artery and the vertebral arteries, bleeding will be slower. If the brachiocephalic artery ruptures, the patient won't be able to maintain an airway and will aspirate blood.

If the external carotid artery ruptures, bleeding is likely to be forceful and rapidly fatal.

Signs of trouble

Observations from careful wound assessment are the most accurate predictors of arterial erosion. Be alert for the following:

* bleeding, pulsations, or artery exposure are obvious signals for concern. Prodromal bleeding may occur 24 to 48 hours before rupture.

* a change in wound color from red to pale or black

* a change in skin temperature from bilaterally warm to unilateral coolness of the face and neck

* edema around the wound and neck, which may signify impaired circulation and lymph drainage

* changes in the type, amount, or odor of wound drainage

* signs of infection, such as redness, tenderness, increased pain, increased temperature, and increased white blood cell count

* pain. The patient may complain of sternal or high epigastric pain several hours before rupture.

Patients at high risk for carotid artery rupture should be on carotid precautions (see A Carotid Precautions Checklist). Your nursing actions will focus on preventing or stopping tissue breakdown and preventing stress on the wound.

Use a nonadherent dressing to keep the wound moist; allow air circulation to discourage microbial growth. If the wound has heavy drainage, use an absorbent dressing and change it frequently to reduce infection risk.

Apply a dressing, such as a gauze wrap, that supports the wound and minimizes stress on it. (For more tips on supporting the wound, see How to Reduce Stress on a Neck Wound.)

These producsts will be helpfull for those who are haveing these issues and they can be bought right from our Medical supply store online Tracheal Care Cleaning, Tracheostomy Cleaning Tray, Cardinal Respiratory Care, Trachestomy Care Tray With Removavable Basin.

Managing a rupture in the hospital

Tell the family of the patient's risk of carotid artery rupture and teach them to report bleeding or patient complaints of sternal or high epigastric pain. Show them where to apply pressure if a rupture occurs while they're visiting and tell them to call for help.

Trach Care-Cleaning, Brushes, Suction Catheters, Pump, Humidification.