· Web viewHumidification: Fisher & Paykel water bath (heated), HME (Swedish Nose) Suction...
-
Upload
nguyenhanh -
Category
Documents
-
view
220 -
download
4
Transcript of · Web viewHumidification: Fisher & Paykel water bath (heated), HME (Swedish Nose) Suction...
SM
R00
0000
Transfer Record for Patient with a Tracheostomy Tube
Patient for transfer from__________________ to ________________________
Date tracheostomy procedure performed: _____ / _____ / __________
Type of procedure performed (circle): Surgical Percutaneous
Date of last tracheostomy tube change: _____ / _____ / __________
Size and Brand of Tracheostomy: ___________________________________________
Type of Tracheostomy (please mark relevant box) Fenestrated Non - Fenestrated Uncuffed Cuffed (Pressure: ________ mm H2O)
Reason for Tracheostomy (please mark relevant box) Aspiration risk Airway maintenance
Secretion clearance Other_____________________________________
Inner cannula insitu: YES NO Oxygen % required: ______________________
Humidification: Fisher & Paykel water bath (heated), HME (Swedish Nose)
Suction Requirements: Size of suction catheters required: __________ Frequency of suction: ________________
Type of secretions/amount: __________________________________________________
Condition of Stoma:Excoriation YES NO Inflammation YES NO
Exudate YES NO Colour/Amount __________________________________
Dressing required___________________________________________________________
Swallow and Speech:Nil by Mouth YES NO or Oral Intake__________________________________
Referred to Speech Therapist_________________________________________________
Speaking Valve YES NO Type of Valve________________________________
Cuff Deflation _____________________________________________________________
Additional information / Concerns with Tracheostomy?
_________________________________________________________________________
Name: ________________________ Signature: _____________________ Date: ____________
Transfer Record for P
atient with a Tracheostom
y Tube
FOR
M #
XX
X00
00 –
00/
0000
This space for form information, notations, trial dates. Etc... Page 1 of 2
BA
RC
OD
E H
ERE