tag:blogger.com,1999:blog-65555211238845040912024-03-13T13:46:29.262-07:00Innovative Cancer Care and RehabilitationSHRUTI AGRAWALhttp://www.blogger.com/profile/10454985849308851427noreply@blogger.comBlogger24125tag:blogger.com,1999:blog-6555521123884504091.post-48300447198995684902023-01-08T15:30:00.000-08:002023-01-08T15:30:12.285-08:00ND SHARMA – TONGUE CANCER Recovery after treatment.<iframe width="480" height="270" src="https://youtube.com/embed/7c2DVJfqV3U" frameborder="0"></iframe>Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-16057127589375161462017-01-28T18:17:00.000-08:002017-01-28T18:17:06.017-08:00Sensitisation program for primary physicians to win over tobacco and cancer 28.1.2017<div dir="ltr" style="text-align: left;" trbidi="on">
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Sensitisation and awareness to win over tobacco and cancer</div>
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Place- uberoi Anand Bareilly</div>
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Participants- 44 doctors of NIMA BAREILLY</div>
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Speaker- Dr Pawan Gupta Mch</div>
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Cancer surgeon</div>
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JAYPEE HOSPITAL Noida</div>
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Advisor- www.ICANCARE.org</div>
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In association with JAYPEE HOSPITAL and ICANWIN FOUNDATION</div>
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Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-82735096010749530632016-11-20T11:15:00.000-08:002016-11-20T11:15:58.681-08:00Win over tobacco and cancer tutorial by Dr Pawan Gupta with rural doctors at Jewar 19.11.2016<div dir="ltr" style="text-align: left;" trbidi="on">
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Win over tobacco and cacner tutorial by Dr Pawan Gupta with rural doctors at Jewar 19.11.2016</div>
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Expert -Dr Pawan Gupta</div>
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Date - 19.11.2016</div>
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No. of Doctors present - 11</div>
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Co hosts - JAYPEE hospital</div>
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I CAN WIN FOUNDATION</div>
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Emphasised on how to advice patients to quit tobacco and not just telling them to quit tobacco.</div>
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The book be smart do not start was shared with all of them.</div>
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Early signs and symptoms of oral cancer and of breast was discussed</div>
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Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-60019688027359095792016-07-09T15:13:00.000-07:002016-07-09T15:13:30.272-07:00CANCER WINNER - A unique person<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><u><span style="font-family: "calibri" , sans-serif; font-size: 11.5pt;">CANCER WINNER - <o:p></o:p></span><span style="font-family: "calibri" , sans-serif; font-size: 15.3333px;">A unique person</span></u></b></div>
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<span style="color: #585858; font-size: 10.5pt;"><b>Dr
Pawan Gupta M.Ch. – Cancer Surgeon, Social Activist and Author</b></span></div>
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<span style="font-family: "calibri" , sans-serif; font-size: 11.5pt;">A person who has experienced Yama (the GOD of Death) from close
quarters, knocking the door - but had to leave empty handed. <o:p></o:p></span></div>
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<span style="font-family: "calibri" , sans-serif; font-size: 11.5pt;">A new Life! A new beginning.<o:p></o:p></span></div>
<div style="margin-bottom: 10.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: "calibri" , sans-serif; font-size: 11.5pt;">A sudden realisation of what is life and a motivation to do
something for the society.<o:p></o:p></span></div>
<div style="margin-bottom: 10.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: "calibri" , sans-serif; font-size: 11.5pt;">A unique turn in life, Life which has now a new meaning.<o:p></o:p></span></div>
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<span style="font-family: "calibri" , sans-serif; font-size: 11.5pt;">CANCER WINNER – A term coined by Dr Pawan Gupta in 2006. This term
is used to describe a cancer patient who has undergone the treatment and is
living with a positive spirit. This was used by him to change the attitude
towards cancer, from “fight against cancer” to “win over cancer”, till then these
patients were described as cancer survivors.</span><o:p></o:p></div>
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<span style="font-size: 11.5pt;">The Cancer Winners encourage the new cancer patients in their respective
areas to undergo treatment and live with a positive spirit and become a winner
like them. The cancer winners share success stories and also issues
related to the disease and life beyond cancer.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
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<span style="font-size: 11.5pt;">Winning is an attitude. Winners are not immortals. But they live in a
positive spirit. There are two ways of living HA HA.. (positive) and hai
hai (poor thing always cursing). The choice is yours. </span><i><span style="font-size: 12pt;">Positive people are happy, loving, generous,
giving, helping, serving people. So they develop magnetic personality and are
honored, loved, respected and even worshipped.</span></i><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
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<i><span style="font-size: 12pt;"><br /></span></i></div>
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<span style="font-size: 11.5pt;">By joining this platform of Cancer Winners you will have an opportunity
to guide someone who looks forward to be a cancer winner him/herself, you share
your experience and motivate others, you guide the doctor community as a whole
as to what they are required to deliver, you spread messages to common
public for lifestyle modification, prevention and early detection, you are an
inspiration to many others to live in a positive spirit.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
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<span style="font-size: 11.5pt;">Categories of </span><span style="font-size: 12pt;">“Cancer Winners” </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
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<span style="font-size: 12pt;">1. Who have suffered through the disease, has or wishes to achieve a
positive state of mind - the spirit of ‘I CAN WIN’</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
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<span style="font-size: 12pt;">2. Care taker of a cancer patient, who wishes to make her/him a winner.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
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<span style="font-size: 12pt;">3. A social person who wishes to be cancer aware and propagate cancer
awareness in the society.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
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<span style="font-size: 12pt;">4. An Oncologist, physician, surgeon or other professionals who believes
in winning over cancer and not just fight against cancer.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
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BE CAREFUL AND NOT FEARFUL.<o:p></o:p></div>
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The ONCOLOGIST by his body language lets the patient know
that – I CAN CARE. Together we can.<o:p></o:p></div>
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There is a positive life beyond cancer.<o:p></o:p></div>
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<a href="http://www.blog.icancare.in/">www.blog.icancare.in</a><o:p></o:p></div>
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<a href="http://www.icancare.blogspot.com/">www.icancare.blogspot.com</a><o:p></o:p></div>
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<a href="http://www.icancare.org/">www.icancare.org</a><o:p></o:p></div>
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Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-76906096584553463032015-12-24T13:29:00.000-08:002015-12-24T13:30:46.335-08:00ONCOLOGIST AS A CANCER WINNER<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="color: #585858; font-size: 10.5pt;">ONCOLOGIST
AS A CANCER WINNER<o:p></o:p></span></div>
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<span style="color: #585858; font-size: 10.5pt;"><b>Dr
Pawan Gupta M.Ch. – Cancer Surgeon, Social Activist and Author</b><o:p></o:p></span></div>
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<span style="color: #585858; font-size: 10.5pt;">Doctor
– An oncologist has a great role to play to make a cancer patient, a cancer
survivor, a winner.<o:p></o:p></span></div>
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<span style="color: #585858; font-size: 10.5pt;">Hand
holding, through the darkest hours of a cancer patient life, during the period
of transformation and thereafter, and how the doctor does it will determine
whether a patient be just a survivor or a winner. <o:p></o:p></span></div>
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<span style="color: #585858; font-size: 10.5pt;">A
cancer patient lives in fear, an unknown fear of life, a life which no one else
can experience.<o:p></o:p></span></div>
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<span style="color: #585858; font-size: 10.5pt;">Early
detection, prompt treatment and quick rehabilitation are the mantra for cancer
patient to become a cancer winner. An oncologist has to understand that
rehabilitation is as much important as treatment, and he has a great role to
play in this.<o:p></o:p></span></div>
<div style="background: white; line-height: 13.65pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="color: #585858; font-size: 10.5pt;">The
following are the important elements of a Good oncologist<o:p></o:p></span></div>
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<span style="color: #585858; font-size: 10.5pt;">Knowledge<o:p></o:p></span></div>
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<span style="color: #585858; font-size: 10.5pt;">Empathy<o:p></o:p></span></div>
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<span style="color: #585858; font-size: 10.5pt;">Spiritualism<o:p></o:p></span></div>
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<span style="color: #585858; font-size: 10.5pt;">Oncologist
has the power to change course of life of a cancer patient.<o:p></o:p></span></div>
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<span style="color: #585858; font-size: 10.5pt;">The
truth is that they have an enormous ability to help their patients and create a
positive impact in their life, which is why they command so much respect. The
problem is that today's oncologists think of themselves primarily as being
intellectual scientists, whose job is to order the right tests, make the right
diagnosis, and provide the right treatment. Believe their work ends here!<o:p></o:p></span></div>
<div style="background: white; line-height: 13.65pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="color: #585858; font-size: 10.5pt;">This
in reality is a very small part of what an oncologist do to help patients become
a winner – Oncologists’ important tasks are far more intangible, and one need
to use the heart much more than the heads to do them well ! He is the bedrock
of support whom the patient can fall back on when she is going through a
rough patch in her life - someone she can trust and depend on during her
darkest hours.<o:p></o:p></span></div>
<div style="background: white; line-height: 13.65pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="color: #585858; font-size: 10.5pt;">The
way we talk, the way we smile, the way we hold our patient's hands, and the way
we connect with her has a far greater impact on the patient's life than just
providing the right diagnosis or the right treatment. This is something which
one should not underestimate.<o:p></o:p></span></div>
<div style="background: white; line-height: 13.65pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="color: #585858; font-size: 10.5pt;">During
times of crisis - and every illness can be filled with stress and loneliness
and angst, a patient needs to know that there is someone she can depend on -
someone who know her, cares for her, and will hold her hand during her darkest
moments - someone who will provide her a shoulder to cry on, and a human
connection.<o:p></o:p></span></div>
<div style="background: white; line-height: 13.65pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="color: #585858; font-size: 10.5pt;">This
is the kind of support which a doctor is privileged to be able to provide, and
we need to understand the significance of this role which we can play in our
patient's lives, which far outweighs anything we can do as regards diagnosis
and treatment. We are far more than technicians , and while we cannot always
cure our patients, we can always provide support and succour!<o:p></o:p></span></div>
<div style="background: white; line-height: 13.65pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="color: #585858; font-size: 10.5pt;">We
are blessed to be in this privileged position, where we are privy to another
human's innermost fears and desires - let's learn to wield this power with care
and compassion<o:p></o:p></span></div>
<div class="MsoNormal">
BE CAREFUL AND NOT FEARFUL.<o:p></o:p></div>
<div class="MsoNormal">
The ONCOLOGIST by his body language lets the patient know
that – I CAN CARE. Together we can.<o:p></o:p></div>
<div class="MsoNormal">
There is a positive life beyond cancer.<o:p></o:p></div>
<br />
<div class="MsoNormal">
www.blog.icancare.in<o:p></o:p></div>
<div class="MsoNormal">
www.icancare.blogspot.com<br />
www.icancare.org</div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-26821819960111403302015-12-05T18:43:00.001-08:002015-12-22T15:28:14.054-08:00Vaginal Dilators<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<b><span style="color: #9f1967; font-family: "Arial","sans-serif"; font-size: 18.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank">I CAN CARE Vaginal Dilators</a> <a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank">http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator</a></span></b><b><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 18.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><span style="color: #9f1967; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Gentle self-treatment for women receiving <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><span style="color: #9f1967; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">1. pelvic radiotherapy for Carcinoma of cervix,
Endometrial carcinoma, Carcinoma of vagina, vulva, other pelvic tumors<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><span style="color: #9f1967; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">2. Post surgery – Hysterectomy, radical vulvectomy,
other pelvic surgery. Abdomino pelvic resection</span></b><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><span style="color: #9f1967; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank"><br /></a></span></b></div>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank">I CAN Care vaginal dilators</a> is a range of dilators
designed to help women alleviate medical conditions affecting the vaginal
structure, following radiotherapy to the vagina, cervix or pelvis. Radiotherapy
can cause some internal scarring (adhesions) to the treated area and make the
vagina narrower, drier and less elastic.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank">I CAN Care vaginal dilators</a> help to reduce the risk
of scarring and offer an effective way for patients to take an active role in
their treatment.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Preventing the formation of scar tissue within the
vagina helps ensure that the vagina remains supple so that sexual intercourse
and vaginal examinations can be performed without discomfort or pain.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank">I CAN CARE Vaginal Dilator </a>is available in three graduated
diameter sizes of 2cm, 2.5 cm and 3 cm to make insertion and removal easier. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Benefits:<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="color: #444444; line-height: 11.7pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Effective
treatment for use in the comfort of the home<o:p></o:p></span></li>
<li class="MsoNormal" style="color: #444444; line-height: 11.7pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Treatment
pace is directed by the user<o:p></o:p></span></li>
<li class="MsoNormal" style="color: #444444; line-height: 11.7pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Three
graduated sizes to help users to progress gradually<o:p></o:p></span></li>
<li class="MsoNormal" style="color: #444444; line-height: 11.7pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Designed
to help build confidence<o:p></o:p></span></li>
</ul>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal">
After menopause, the vagina becomes dry, less elastic,
narrower, and shorter. Some cancer treatments can also cause these changes
within the vagina. To help you with these changes, your healthcare provider has
suggested that you use a vaginal dilator and start doing vaginal dilator
therapy. Vaginal dilator therapy is a resource you can use throughout your
life. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It will help to: <o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]-->1.<span style="font-size: 7pt; font-stretch: normal;">
</span><!--[endif]-->Allow your healthcare provider to perform a more
thorough pelvic exam. <o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]-->2.<span style="font-size: 7pt; font-stretch: normal;">
</span><!--[endif]-->Make it more comfortable for you to be examined.
<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]-->3.<span style="font-size: 7pt; font-stretch: normal;">
</span><!--[endif]-->Prevent your vagina from becoming too narrow.<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]-->4.<span style="font-size: 7pt; font-stretch: normal;">
</span><!--[endif]-->Keep your vagina more elastic. <o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]-->5.<span style="font-size: 7pt; font-stretch: normal;">
</span><!--[endif]-->Allow you to have vaginal sex with less
discomfort. <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 11.7pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal">
As a result of your recent treatment, your vagina may have
become narrowed and shortened due to the formation of scar tissue. <span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 9.0pt; line-height: 115%; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">I CAN CARE</span> vaginal dilators have been
designed to greatly reduce your risk of scarring and assist you in keeping your
vagina supple. This will help reduce any long term discomfort from follow up
examinations, further treatments and sexual intercourse. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Please read these instructions fully before using <a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 9.0pt; line-height: 115%; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">I CAN CARE</span> vaginal dilators</a> for the first
time<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><u>How to use your </u></b><b><u><a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 9.0pt; line-height: 115%; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">I CAN CARE</span> vaginal dilators </a><o:p></o:p></u></b></div>
<div class="MsoNormal">
<b>Before You Begin</b> – Prior to first-time use, wash
dilators and handle in warm, soapy water, rinse thoroughly and allow to dry. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Privacy</b> – Use the dilators in a private, comfortable
setting where you will be undisturbed. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Positioning</b> – The recommended position to use the
dilators is to lie flat on your back with your knees bent at a 45 degree angle and
legs slightly apart. Alternatively, you may stand with one leg raised on a
chair. Make sure you can easily touch
the opening of your vagina. Practice Kegel exercise.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Progression</b> – Start with the smallest dilator and,
once you can comfortably insert it, progress to the next size up. You may find
when you first use the dilators that you can only tolerate the tip of the
dilator. With persistent use you will be able to gradually progress to full
insertion, then larger sizes. When transitioning sizes, move from the smaller
dilator to the next size in the same session, as vaginal muscles will already
be relaxed and the transition will be easier. The time it takes to progress
from size to size varies by individual. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Inserting a <a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank">Vaginal Dilator</a></b> -- 1. Apply water-based
lubricant (like K-Y jelly), to the tip of the dilator and to your vaginal
opening. Do not use petroleum jelly (like Vaseline) 2. Relax as best as
possible. Using controlled breathing, slowly ease the dilator into the vagina
going as deeply as is comfortable. Continue to insert the dilator until you
feel slight discomfort or muscle tension and then stop. Since the vagina slants
upwards and towards your back, the dilator should be angled upwards and in the
direction of your back during insertion. 3. Once the dilator is inside the vagina move
the dilator in a forward and backward motion, then a left to right motion and
if possible, gently rotate the dilator in position by twisting the handle.4. Do
a set of Kegel exercises. These Exercises will help you relax your pelvic floor
muscles and insert the dilator a little further. If it is still difficult to insert the dilator
after doing Kegel exercises, take some deep breaths. Then, refocus on relaxing
your pelvic floor muscles and try to insert the dilator a little further. Don’t
worry if you can’t insert the dilator completely. Over time, you may be able to
get the dilator in a little bit further. 5. Leave the dilator in place for 5 to
10 minutes. 6. Gently push it back and forth to stretch the length of your
vagina. 7. Gently rotate the dilator in wide circles to stretch the width of
your vagina. Repeat this at the back, middle, and opening of your vagina. Some
women find it helpful to work with more than one size dilator. 8. Remove gently
and slowly while rotating. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
After You Are Done You may have a small amount of bleeding
when you use the dilator. This is normal. A panty liner will be enough to
manage this. If you have a lot of bleeding, such as bleeding that soaks up a
sanitary napkin, call your healthcare provider. If you get urinary tract
infections (UTIs) often, you may want to urinate after dilator therapy. If you
have any questions or problems, talk with your healthcare provider at your next
appointment. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Duration & Frequency</b> – You should practice dilator
therapy several times per week (i.e., every other day). The more you do it, the
more you will benefit. Duration and frequency of dilation may range from three
minutes twice a week up to ten minutes and twice daily*. Please consult with
your Healthcare Professional. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Cleaning Instructions</b> – <a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank">I CAN CAREvaginal dilators</a>, should be washed after each use. Wash in warm, soapy water,
rinse thoroughly and allow to dry before storing in in a clean bag. Ensure all
traces of soap are removed to avoid irritation. Remember to wash the dilator
handle if it has been used.<o:p></o:p></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: 11.7pt; mso-border-alt: solid windowtext .5pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in;">
<span style="background: yellow; mso-highlight: yellow;">Warnings and Precautions<o:p></o:p></span></div>
<div class="MsoNormal" style="border: none; line-height: 11.7pt; mso-border-alt: solid windowtext .5pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in;">
<span style="background: yellow; mso-highlight: yellow;"> These instructions
are intended as a guide. Further advice may be obtained from your Healthcare
Professional.</span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-bidi-language: HI; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></div>
</div>
<br />
<div class="MsoNormal">
<span style="background: white; color: #333333; font-family: "Verdana","sans-serif";">Return Policy: We are not able to accept returns on the
vaginal dilator product. For health and safety reasons, vaginal inserts,
vaginal dilators that have been sold to a consumer cannot be restocked and are
prohibited from resale.<a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator" target="_blank">I CAN CARE Vaginal Dilators</a></span><o:p></o:p><br />
<br />
<a href="http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator">http://www.icancare.org/treatment/radiotheraphy/vaginal-dilator</a></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-51675986007485340882015-10-04T04:22:00.000-07:002015-10-04T04:22:56.731-07:00Tracheostomy Humidification<div dir="ltr" style="text-align: left;" trbidi="on">
<h1 style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Tracheostomy Humidification<o:p></o:p></span></h1>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The nose and mouth provide warmth, moisture and filtration for
the air we breathe. Having a tracheostomy tube, however, by-passes these
mechanisms so humidification must be provided to keep<span class="apple-converted-space"> </span><a href="http://www.hopkinsmedicine.org/tracheostomy/resources/glossary.html#Stoma" target="_blank">secretions</a><span class="apple-converted-space"> </span>thin
and to avoid mucus plugs. To keep the environment at an optimal humidity level,
follow the procedures below.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Equipment<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Air
compressor<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;"><a href="http://www.hopkinsmedicine.org/tracheostomy/resources/glossary.html#Larynx" target="_blank">Nebulizer bottle</a><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Aerosol
tubing<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;"><a href="http://www.hopkinsmedicine.org/tracheostomy/resources/glossary.html#TrachTies" target="_blank">Trach mask</a><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Sterile
water<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;"><a href="http://www.hopkinsmedicine.org/tracheostomy/resources/glossary.html#Stoma" target="_blank">Saline ampules</a><span class="apple-converted-space"> </span>(“bullets”)<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;"><a href="http://www.hopkinsmedicine.org/tracheostomy/resources/glossary.html#Tracheotomy" target="_blank">Heat Moisture Exchanger</a><span class="apple-converted-space"> </span>(HME) Also known by several other
terms including: Thermal Humidifying Filters, Swedish nose, Artificial
nose, Filter, Thermovent T.<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Room/home
humidifiers<o:p></o:p></span></li>
</ul>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Attach a mist collar (trach mask) with aerosol tubing over the
trach with the other end of tubing attached to the nebulizer bottle and air
compressor. Sterile water goes into the nebulizer bottle (do not overfill, note
line guide). Oxygen can also be delivered via the mist collar if needed.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Heated mist may be ordered. Heated mist is accomplished by an
electric heating rod that fits into the nebulizer bottle. Extra care should be
taken to be sure the bottle does not go dry, which could melt plastic. Many of
these heating elements do not have automatic shut-offs and this could be a
potential fire hazard. Also, more moisture will accumulate in the aerosol
tubing with heated mist. Moisture that accumulates in the aerosol tubing must
be removed frequently to prevent occlusion (blocking) of the tube and/or
accidental aspiration (inhalation). Disconnect tubing at the trach end, empty
into a container and discard. Do not drain fluid into the humidifying unit.
Fluid traps (or drainage bags) are helpful in preventing occlusion and
aspiration. These collection devices also need to be emptied frequently.
Position the air compressor and tubing lower than the patient to help prevent
aspiration from moisture in the tubing. A mist collar can also be worn during
the day when mucus is thick or blood tinged. Sterile saline drops can be
instilled into the trach tube if secretions become thick and difficult to
suction. A saline nebulizer treatment is also helpful to loosen secretions if
the patient has a nebulizer machine. Additional fluid intake also helps to keep
secretions thinner.<o:p></o:p></span></div>
<br />
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Secretions can be kept thin during the day by applying a Heat
Moisture Exchanger (HME) to the trach tube. An HME is a humidifying filter that
fits onto the end of the trach tube and comes in several shapes and sizes (all
styles fit over the standard trach tube opening). There are also HME’s
available for portable ventilators. Bedside ventilators have built-in
humidifiers. HME’s also help prevent small particles from entering the trach
tube. Change HME daily and as needed if soiled or wet.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Source - </span><span style="background-color: transparent; font-size: 12px;"><span style="color: #4a4a4a; font-family: Arial, sans-serif;">http://www.hopkinsmedicine.org/tracheostomy</span></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br /></span></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-85027902612469478962015-10-04T04:01:00.000-07:002015-10-04T04:01:26.486-07:00Tracheostomy Equipment<div dir="ltr" style="text-align: left;" trbidi="on">
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Tracheostomy
Equipment<o:p></o:p></span></h1>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Tracheostomy
Supplies<o:p></o:p></span></h2>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Tracheostomy tubes of the appropriate type and size<br />
Tracheostomy tube (one size smaller)<br />
Trach tube ties or velcro strap<br />
Dressing supplies, gauze<br />
Hydrogen peroxide, sterile water, normal saline<br />
Water soluble lubricant such as Surgilube or KY Jelly<br />
Blunt-end bandage scissors<br />
Tweezers or hemostats<br />
Sterile Q-tips<br />
Trach care kits and/or pipe cleaners (double-cannula trach tubes)<br />
Luer lock syringes for cuffed trach tubes<o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Suction
Equipment<o:p></o:p></span></h2>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Portable battery-powered suction machine<br />
Suction connecting tubing<br />
Suction catheters<br />
Normal saline solution<br />
Sterile jars with screw tops (sterile specimen containers or sterilized baby
food jars work well)<br />
Saline ampules (“bullets“)<br />
Bulb syringe<br />
DeLee suction trap or syringe with catheter<br />
Hand-powered Suction Devices A simple yet efficient suction unit for
first responders, and a reliable backup for emergency healthcare
providers.<br />
YanKauer Suction Handle<br />
Sims Connector<o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Humidification
System<o:p></o:p></span></h2>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Air compressor<br />
Nebulizer bottles<br />
Tracheostomy mask<br />
Aerosol tubing<br />
Water trap</span><span class="apple-converted-space"><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">HeatMoisture Exchanger </span></span><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">(HME) (If you don't have an HME, use a
room humidifier)<br />
Room humidifier<br />
Sterile water<br />
Mist heater (if ordered)<br />
Croup or mist tent (rarely ordered today)<br />
Vapotherm<o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;"><br />
Other Supplies That You May or May Not Need<o:p></o:p></span></h2>
<br />
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Hand washing supplies<br />
Cleaning supplies<br />
Mucus traps for sputum specimens<br />
Sterile or clean paper cups<br />
Tissues<br />
Manual resuscitation (Ambu) bag with mask and trach adapter<br />
Intercom, baby monitor or video monitor<br />
Thermometer<br />
Stethoscope<br />
Disposable Gloves (powder free)<br />
Trach scarf or bib<br />
Rolled-up towel<br />
Other Possible Equipment Needs<br />
Speaking valves<br />
Trach guard<br />
Cardiac/Apnea monitor<br />
CO2 monitor<br />
Pulse oximeter<br />
Oxygen<br />
Oxygen Concentrator<br />
Oxygen Supply tubing<br />
<a href="http://www.hopkinsmedicine.org/tracheostomy/resources/glossary.html#Tracheotomy" target="_blank">Ventilator</a><br />
BiPAP<br />
Nebulizer Equipment (Aerosolized medication delivery system)<br />
Dura-neb Portable Compressor/Nebulizer<br />
DeVilbiss® Pulmo-Aide® Compact Compressor/Nebulizer<br />
AeroTrach Plus™<br />
Pressure manometer to check trach cuff pressure on cuffed tubes<br />
Extra smoke detectors and a fire extinguisher suitable for electric as well as
regular fires.<br />
Consider an emergency generator if you have frequent power failures.<o:p></o:p></span></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-9867755942206381352015-10-03T07:04:00.000-07:002015-10-03T07:04:48.527-07:00Decannulation of Tracheostomy<div dir="ltr" style="text-align: left;" trbidi="on">
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Decannulation of Tracheostomy<o:p></o:p></span></h1>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Definition:</span></strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br />
The process whereby a<span class="apple-converted-space"> tracheostomy</span><span class="apple-converted-space"> </span>tube
is removed once patient no longer needs it.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Indication:</span></strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br />
When the initial indication for a tracheostomy no longer exists.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Requirements:</span></strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">A patient is considered a candidate for decannulation<span class="apple-converted-space"> </span>once
the following conditions are met.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Patient is alert and oriented and responsive to commands.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Patient is no longer dependent on a ventilator for assisted
breathing.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The frequency requirement for tracheal suctioning is less than
once a day. (This is not always the case. Check with your physician)<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Patient has met the criteria for decannulation outlined below.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Criteria for<span class="apple-converted-space"> decannulation</span><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Patient should not be dependent on a ventilator.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Patient’s mental status should be to the level of alert and
responsive and should be able to manage their oral secretions without a risk of
aspiration.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Should not require frequent suctioning for tracheal<span class="apple-converted-space"> secretions</span>.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Patient should be able to cough and clean his/ her tracheal
secretions.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The patient should have their tracheostomy tube downsized to a
size 4 Shiley or similar tracheostomy tube and they should not have breathing
difficulty in the presence of this tube.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The size 4 Shiley or similar tube should be occluded (with a
trach plug/ cork) for twelve hours during the day with close monitoring by the
nursing staff with no evidence of respiratory difficulty or requiring of
suctioning of the trach tube.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Once the patient is seen to tolerate the steps in item # 6
above, their trach is plugged for twenty four hours and they are monitored for
respiratory difficulty or suction requirement.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Decannulation:</span></strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Once all of the above criteria are met, the patient is informed
that their trach tube is going to be removed. They are instructed that they may
experience a sensation of shortness of breath for a few minutes once they are
decannulated.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Arrangements should be made for back-up personnel (RT or RN) to
be available in case of emergency. Decannulation is usually not done at home.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The patient is placed supine (flat) on their bed, the tube is
removed and the opening into the neck is covered with sterile gauze and a tape
is placed over the gauze.<o:p></o:p></span></div>
<br />
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The patient is instructed to occlude the gauze with their finger
tip every time they cough or speak so that air does not leak. They should
change the gauze and the tape at least once a day (more often as needed) until
the hole in the neck heals itself closed over the next few days to weeks. In a
minority of patients (<10 %), the opening into the neck skin has to be
surgically closed.<o:p></o:p></span></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-638384836770854872015-10-03T06:55:00.000-07:002015-10-03T06:55:26.343-07:00Making sterile salt water (saline) for home suctioning/use<div dir="ltr" style="text-align: left;" trbidi="on">
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Making
sterile salt water (saline) for home suctioning/use<o:p></o:p></span></h2>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Start with clean hands, pans, containers and spoon<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Put saline storage jar and lid in one pan and cover with tap
water.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Put 4 ¼ cups of tap water in a second pan.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Boil both pans for ten minutes.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Add two level teaspoons of table salt to plain boiled tap water
and stir to dissolve. Cool both pans to room temperature.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Remove storage jar and lid touching only the outside.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Pour cooled salt water directly into storage jar. Place
lid tightly on jar. Store in refrigerator.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Pour off the amount needed for each cleaning or suctioning
session into a smaller container. Do not dip anything into the large
supply of saline.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Make a new batch every day.<o:p></o:p></span></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-11695491632444730442015-10-03T06:48:00.000-07:002015-10-03T06:48:35.486-07:00Tracheostomy Stoma Care<div dir="ltr" style="text-align: left;" trbidi="on">
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;"><br /></span></h1>
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Tracheostomy Stoma Care<o:p></o:p></span></h1>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The buildup of mucus and the rubbing of the<span class="apple-converted-space"> tracheostomy</span><span class="apple-converted-space"> </span>tube
can irritate the skin around the stoma. The skin around the<span class="apple-converted-space"> stoma</span><span class="apple-converted-space"> </span>should
be cleaned at least twice a day to prevent odor, irritation and infection. If
the area appears red, tender or smells badly, stoma cleaning should be
performed more frequently. Call your surgeon’s office if a rash, unusual odor,
and/or yellowish-green drainage appears around the stoma.<o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Equipment:<o:p></o:p></span></h2>
<ul type="disc">
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Face
cloth<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Cotton-tipped
applicators<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Hydrogen
peroxide (1/2 strength - equal parts peroxide and water)<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Normal
saline<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Vaseline guaze 2x2 dressing (optional)<o:p></o:p></span></li>
</ul>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Wash your hands.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Remove any dressing around the tracheostomy (if applicable). The
tube should not have to be removed to clean the stoma.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Dip the cotton tip applicators in the hydrogen peroxide (saline
can be used if the peroxide is too irritating) and use it to clean around the
stoma site. Start as close as possible to the tracheostomy tube then work away
from it.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Repeat the process until debris and/or mucus is removed.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Use a dry cotton tip applicator or face cloth to dry the skin.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">No gauze should be placed under the trach tube unless
recommended by the treating physician. A dry dressing is helpful if the
patient has areas of skin irritation or secretions. <o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Daily Care<o:p></o:p></span></h2>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Rubbing of the trach tube and secretions can irritate the skin
around the stoma. Daily care of the trach site is needed to prevent infection
and skin breakdown under the tracheostomy tube and ties. Care should be done at
least once a day; more often if needed. Patients with new trachs or on ventilators<span class="apple-converted-space"> </span>may
need trach care more often. Tracheostomy dressings are used if there is
drainage from the tracheostomy site or irritation from the tube rubbing on the
skin.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">It may be helpful to set up a designated spot in the home for
equipment and routine tracheostomy care.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Equipment</span></strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l3 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Sterile
cotton tipped applicators (Q-tips) <o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l3 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Trach
gauze<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l3 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Sterile
water<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l3 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Hydrogen
peroxide (1/2 strength with sterile water)<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l3 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Trach
ties and scissors (if ties are to be changed) <o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l3 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Two
sterile cups or clean disposable paper cups<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l3 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Small
blanket or towel roll<o:p></o:p></span></li>
</ul>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br />
</span><strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Procedure</span></strong><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Wash your hands. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Make sure the patient is laying in a comfortable position on
his/her back with a small blanket or towel roll under his/her shoulders to
extend the neck and allow easier visualization and trach care.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Open sterile cotton, trach gauze and regular gauze.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Cut the trach ties to appropriate length (if trach ties are to
be changed).<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Pour 1/2 strength hydrogen peroxide into one cup and sterile
water into the other.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Clean the skin around the trach tube with sterile cotton soaked in 1/2
strength hydrogen peroxide. Using a rolling motion, work from the center outward
using 4 swabs, one for each quarter around the stoma and under the flange of
the tube. Do not allow any liquid to get into trach tube or stoma area under
the tube. Note: We recommend cleaning with just soap and water in home
care, using hydrogen peroxide only to remove encrusted secretions. This is
because daily use of hydrogen peroxide might irritate the skin, especially in
cases with small children.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Rinse the area with cotton soaked in sterile water.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Pat dry with gauze pad or dry sterile cotton.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">9.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Change the trach ties if needed.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">10.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Check the skin under the trach ties.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">11.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">For tracheostomy tubes with cuffs, check with your surgeon’s
office for specific cuff orders. Check cuff pressure every 4 hours (usual
pressure 15 - 20 mm Hg). In general, the cuff pressure should be as low as
possible while still maintaining an adequate seal for ventilation.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">12.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Monitor skin for signs of infection. If the stoma area becomes
red, swollen, inflamed, warm to touch or has a foul
odor, or if the patient develops a fever, call
your surgeon’s office.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">13.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Check with the doctor before applying any salves or ointments
near the trach. If an antibiotic or antifungal ointment is ordered by one of
our doctors, apply the ointment lightly with a cotton swab in the direction
away from the trach stoma.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">14.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Wash your hands after each trach care.<o:p></o:p></span></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com4tag:blogger.com,1999:blog-6555521123884504091.post-81822026075019520972015-10-03T06:41:00.000-07:002015-10-03T06:41:00.584-07:00Tracheostomy Suctioning<div dir="ltr" style="text-align: left;" trbidi="on">
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Tracheostomy Suctioning<o:p></o:p></span></h1>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The upper airway warms, cleans and moistens the air we breathe.
The trach tube bypasses these mechanisms, so that the air moving through the
tube is cooler, dryer and not as clean. In response to these changes, the
body produces more mucus. Suctioning clears mucus from the<span class="apple-converted-space"> tracheostomy </span>tube and is essential for proper breathing.
Also,<span class="apple-converted-space"> secretions</span><span class="apple-converted-space"> </span>left
in the tube could become contaminated and a chest infection could
develop. Avoid suctioning too frequently as this could lead to more
secretion buildup.<o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Removing
mucus from trach tube without suctioning<o:p></o:p></span></h2>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Bend forward and cough. Catch the mucus from the tube, not from
the nose and mouth.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Squirt sterile normal<span class="apple-converted-space"> saline solutions</span><span class="apple-converted-space"> </span>(approximately
5cc) into the trach tube to help clear the mucus and cough again.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Remove the inner tube (cannula).<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Suction.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">5. If still the breathing is not adequate</span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: #4a4a4a; font-family: Arial, sans-serif; font-size: 9pt; line-height: 14.25pt; text-indent: -0.25in;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><span style="color: #4a4a4a; font-family: Arial, sans-serif; font-size: 9pt; line-height: 14.25pt; text-indent: -0.25in;">Remove the entire trach tube and try to place the spare tube.</span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Continue trying to cough, instill saline, and suction until
breathing is normal or help arrives.<o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">When to
suction<o:p></o:p></span></h2>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Suctioning is important to prevent a mucus plug from blocking
the tube and stopping the patient's breathing. Suctioning should be
considered<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Any
time the patient feels or hears mucus rattling in the tube or airway<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">In
the morning when the patient first wakes up<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">When
there is an increased respiratory rate (working hard to breathe)<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Before
meals<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Before
going outdoors<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Before
going to sleep<o:p></o:p></span></li>
</ul>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The secretions should be white or clear. If they start to change
color, (e.g. yellow, brown or green) this may be a sign of infection. If the
changed color persists for more than three days or if it is difficult to keep
the tracheostomy tube intact, call your surgeon's office. If there is blood in
the secretions (it may look more pink than red), you should initially increase
humidity and suction more gently. A Artificail humidifier, which is a cap that can
be attached to the tracheostomy tube, may help to maintain humidity. The cap
contains a filter to prevent particles from entering the airway and maintains
the patient's own humidity. Putting the patient in the bathroom with the door
closed and shower on will increase the humidity immediately. If the patient
coughs up or has bright red blood mucus suctioned, or if the patient develops a
fever, call your surgeon's office immediately.<o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">How to
suction<o:p></o:p></span></h2>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Equipment<br />
Clean suction catheter (Make sure you have the correct size)<br />
Distilled or sterile water<br />
Normal saline<br />
Suction machine in working order<br />
Suction connection tubing<br />
Jar to soak inner cannula (if applicable)<br />
Tracheostomy brushes (to clean tracheostomy tube)<br />
Extra tracheostomy tube<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Wash your hands.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Turn on the suction machine and connect the suction connection
tubing to the machine.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Use a clean suction catheter when suctioning the patient.
Whenever the suction catheter is to be reused, place the catheter in a
container of distilled/sterile water and apply suction for approximately 30
seconds to clear secretions from the inside. Next, rinse the catheter with
running water for a few minutes then soak in a solution of one part vinegar and
one part distilled/sterile water for 15 minutes. Stir the solution frequently.
Rinse the catheters in cool water and air-dry. Allow the catheters to dry in a
clear container. Do not reuse catheters if they become stiff or cracked.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Connect the catheter to the suction connection tubing.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Lay the patient flat on his/her back with a small towel/blanket
rolled under the shoulders. Some patients may prefer a sitting position which
can also be tried.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Wet the catheter with sterile/distilled water for lubrication
and to test the suction machine and circuit.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Remove the inner<span class="apple-converted-space"> cannula</span><span class="apple-converted-space"> </span>from
the tracheostomy tube (if applicable). The patient may not have an inner
cannula. If that is the case, skip this step and go to number 8.<br />
<br />
<strong>a.</strong><span class="apple-converted-space"> </span>There are different types of inner
cannulas, so caregivers will need to learn the specific manner to remove their
patient's. Usually rotating the inner cannula in a specific direction will
remove it.<br />
<br />
<strong>b.</strong><span class="apple-converted-space"> </span>Be careful not to accidentally remove
the entire tracheostomy tube while removing the inner cannula. Often by
securing one hand on the tracheostomy tube?s flange (neck plate) one can/ will
prevent?accidental removal.<br />
<br />
<strong>c.</strong><span class="apple-converted-space"> </span>Place the inner cannula in a jar for
soaking (if it is disposable, then throw it out).<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Carefully insert the catheter into the tracheostomy tube. Allow
the catheter to follow the natural curvature of the tracheostomy tube. The
distance to the location of catheter becomes easier to determine with
experience. The least traumatic technique is to pre-measure the length of the
tracheostomy tube then introduce the catheter only to that length. For example
if the patient?s tracheostomy tube is 4 cm long, place the catheter 4 cm into
the tracheostomy tube. Often, there will be instances when this technique of
suctioning (called tip suctioning) will not clear the patient?s secretions. For
those situations, the catheter may need to be inserted several mm beyond the
end of the tracheostomy tube (called deep suctioning). With experience,
caregivers will be able to judge the distance to insert the tracheostomy tube
without measuring.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">9.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Place your thumb over the suction vent (side of the catheter)
intermittently while you remove the catheter. Do not leave the catheter in the
tracheostomy tube for more than 5-10 seconds since the patient will not be able
to breathe well with the catheter in place.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">10.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Allow the patient to recover from the suctioning and to catch
his/her breath. Wait for at least 10 seconds.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">11.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Suction a small amount of distilled/sterile water with the
suction catheter to clear any residual debris/secretions.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">12.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Insert the inner cannula from extra tracheostomy tube (if
applicable).<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">13.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Turn off suction machine and discard catheter (clean according
to step 3 if to be reused).<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">14.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Clean inner cannula (if applicable).<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br /></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br /></span></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-24602681652217703292015-10-03T06:28:00.000-07:002015-10-03T06:28:37.455-07:00Cleaning and Caring for Tracheostomy Equipment<div dir="ltr" style="text-align: left;" trbidi="on">
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Cleaning and
Caring for Tracheostomy Equipment</span></h1>
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #4c689a; font-family: Arial, sans-serif; font-size: 13.5pt; font-weight: normal; line-height: 115%;"><br /></span></h1>
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #4c689a; font-family: Arial, sans-serif; font-size: 13.5pt; font-weight: normal; line-height: 115%;"><br /></span></h1>
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #4c689a; font-family: Arial, sans-serif; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Cleaning suction catheters at home</span></h1>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Suction catheters must be cleaned after each session of
suctioning. This helps prevent infection as well as helps cut down costs by
reusing the same catheter for one week.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">After suctioning the trach tube:<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l3 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Pour a few ounces of hydrogen peroxide into a small clean
container.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l3 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Suction hydrogen peroxide through the catheter until it is free
of mucus. Wipe the outside of the catheter with a cloth or gauze wet with
peroxide.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l3 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Suction sterile salt water through the catheter until it is free
of peroxide.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l3 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Suction air until the catheter is free of water.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l3 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Remove the catheter from the connecting tubing and let it air
dry.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l3 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Wrap it in a clean dry towel.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l3 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Use it as needed with this cleaning process each time for up to
8 hours, then THROW IT AWAY.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l3 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Follow manufacturer's instruction for cleaning and disinfecting
your suction machine and humidifier. Do not allow water to stand in your
humidifier when not in use.<o:p></o:p></span></div>
<h2 style="background: white;">
<a href="https://www.blogger.com/null" name="inner"></a><span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Cleaning the tracheostomy inner cannula tube (for reusable inner
cannulas only)<o:p></o:p></span></h2>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The tracheostomy inner cannula tube should be cleaned two to
three times per day or more as needed. Please note that this only applies to
reusable inner cannulas.Cleaning is needed more immediately after surgery and
when there is a lot of mucus buildup.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<a href="https://www.blogger.com/null" name="trach"></a><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Equipment<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l1 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Small
brush or pipe cleaners<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l1 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Half-strength
solution of hydrogen peroxide (1/2 water, 1/2 hydrogen peroxide)<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l1 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Saline
or homemade sterile salt water<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l1 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Two
small bowls<o:p></o:p></span></li>
</ul>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Procedure<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Wash your hands.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Place 1/2 strength peroxide solution in one bowl and sterile
salt water in second bowl.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Remove the inner cannula while holding the neck plate of the
trach still.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Place inner cannula in peroxide solution and soak until crusts
are softened or removed.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Use the brush or pipe cleaner to clean the inside, outside and
creases of the tube.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Do not use scouring powder or Brillo pads.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Look inside the inner cannula to make sure it is clean and clear
of mucus.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Rinse tube in saline or sterile salt water.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">9.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Re-insert it while holding the neck plate of the trach still.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">10.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Turn the inner cannula until it locks into position.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">11.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Double check the locking pulling forward gently on the inner
cannula.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br /></span></div>
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Tracheostomy
Complications<o:p></o:p></span></h1>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br /></span></div>
<div style="background: white; margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The surgeon will perform the first<span class="apple-converted-space"> tracheostomy</span><span class="apple-converted-space"> </span>tube
change to ensure that the<span class="apple-converted-space"> stoma</span><span class="apple-converted-space"> </span>and
tracheostomy site heal properly. If the stoma is ready (usually 1-2 weeks
after surgery), the otolaryngology team will teach the caregivers how perform a
tube change. It is important that caregivers feel confident and competent
in tube changing before leaving the hospital in case an emergency tube change
is needed. The procedure is not without risks and in order to be as safe
as possible, it is important to have two people present. <o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><span class="apple-converted-space">Secretions </span>from
the lungs coat the inside of the tracheostomy tube requiring the tube to be
changed once a week, although some patients may be fitted with a different tube
that can be left in longer. The tube may have to be changed more often if
secretions become very dry or if the patient has a chest infection and is
producing more and thicker secretions. Always change the trach tube before
a feeding or wait for at least two hours after a feeding to avoid vomiting and
resulting spillage of vomitus into the windpipe.<o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Instructions
for tube changing<o:p></o:p></span></h2>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Prepare equipment:<br />
- Suction catheter and suction machine in working order<br />
- two lengths of 1/4 inch cotton tapes or Velcro strap<br />
- new tube - check correct size and that the tube is intact and in good order<br />
- a smaller sized tube (one incremental size smaller) in case the usual one
will not go in<br />
- water-based lubricant to prevent the tube sticking to the skin as it is
inserted<br />
- round-ended scissors<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Wash your hands.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Prepare tube - take out of wrapping and hold by the flanges. Put
in introducer (if applicable). Carefully apply a small amount of lubricant to
the outer side of the end of the tube, ensuring no lubricant gets into the ends
of the tube. Place the ties or strap on the new tube. Place the tube on the
wrapper.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Have all equipment within easy reach.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Suction if necessary.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Position the patient as you do for tape changing.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Have one person hold the tube while the other cuts and remove
the dirty tapes and place clean tapes behind the patient’s neck.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">The tube should continue to be held while the other person holds
the new tube by the flanges and positions the tip near the patient’s neck.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">9.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Gently remove the old tube following the curve of the tube.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">10.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Firmly and gently slide in the new tube, again following the
curve of the tube so as not to damage the<span class="apple-converted-space"> trachea</span>. Remove introducer if this has been used.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">11.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Hold the new tube securely in place -
changing the tube may cause the patient to cough, which could dislodge it.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">12.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Allow the coughing to settle. Check air flow through the
tracheostomy tube by feeling the air flow onto your hands and the patient’s
breathing pattern and color. Suction if necessary.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">13.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Clean and observe the skin around the tube.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">14.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Tie the tapes.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
</div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt; mso-fareast-font-family: Arial;">15.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Do not let go of the tube until the tapes are secure.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br /></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-left: .5in; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br /></span></div>
<div class="MsoNormal" style="background: white; margin-left: 0.5in; text-indent: -0.25in;">
<span style="color: #4a4a4a; font-family: Arial, sans-serif; font-size: 9pt; line-height: 14.25pt;">Source:</span><span style="background-color: transparent; font-size: 12px; line-height: 19px;"><span style="color: #4a4a4a; font-family: Arial, sans-serif;">http://www.hopkinsmedicine.org/tracheostomy</span></span></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-19668898379342893262015-10-03T06:17:00.000-07:002015-10-03T06:17:33.171-07:00Eating with a Tracheostomy<div dir="ltr" style="text-align: left;" trbidi="on">
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Eating with a
Tracheostomy<o:p></o:p></span></h1>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Having a tracheostomy usually will not affect the patient's
eating or swallowing patterns. Sometimes there are changes in swallowing
dynamics that require adjusting to, but it is rare that this cannot be overcome
in a short time. If swallowing problems do occur, it is usually due to limited
elevation of the<span class="apple-converted-space"> larynx(voice box)</span><span class="apple-converted-space"> </span>or
poor closure of the epiglottis and vocal cords, which allows food or fluids
into the trachea. The speech pathologist may be able to develop
ways to improve swallowing if there is a problem.<o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Indications
of a Swallowing Problem<o:p></o:p></span></h2>
<ul type="disc">
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Difficulty
or refusing to eat<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Over-reaction
or no reaction to food in the mouth<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Choking
and coughing while eating or drinking<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Vomiting<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Evidence
of food in tracheostomy secretions<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Excessive
drooling<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Large
amounts of watery secretions from trach<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Congested
lung sounds<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #4a4a4a; line-height: 14.25pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Frequent
respiratory infections<o:p></o:p></span></li>
</ul>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">If the patient eats by mouth, it is recommended that the
tracheostomy tube be suctioned prior to eating. This often prevents the need
for suctioning during or after meals, which may stimulate excessive coughing
and could result in vomiting.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Encouraging fluid intake is helpful for a patient with a
tracheostomy. Increased fluid intake will thin and loosen secretions making
coughing and suctioning easier.<o:p></o:p></span></div>
<br />
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Always observe the patient while eating to be sure food does not
get into the trach.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br /></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Source: </span><span style="background-color: transparent; font-size: 12px;"><span style="color: #4a4a4a; font-family: Arial, sans-serif;">http://www.hopkinsmedicine.org/tracheostomy</span></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br /></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;"><br /></span></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-30686634990714493972015-10-03T06:11:00.000-07:002015-10-03T06:11:39.557-07:00Speech with a Tracheostomy<div dir="ltr" style="text-align: left;" trbidi="on">
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Speech with a
Tracheostomy<o:p></o:p></span></h1>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Normally speech is obtained by a steady stream of air that comes
from the lungs and passes through the vocal cords. When the trach tube is
inserted, most of the air bypasses the vocal cords and goes out through the
tube. Some air may leak up to the vocal cords, but it may not be forceful
enough to drive the vocal cords into vibration, or it may only allow enough
force for very short utterances. <o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">All trach tubes should fit easily into the airway with some
space around the tube. If the tube fits snugly inside the<span class="apple-converted-space"> trachea</span>, all of the exhaled air will leave the body via the<span class="apple-converted-space"> tracheostomy</span><span class="apple-converted-space"> </span>tube
and no air will be able to pass through the vocal cords. If mechanical<span class="apple-converted-space"> ventilation</span><span class="apple-converted-space"> </span>is
needed, a more “fitted” trach may be required. If the airway is
very small, scarred, or has a granuloma, the patient may not be able to move
enough air past the vocal cords to vocalize. If the vocal cords are scarred or
paralyzed, the patient’s voice may sound hoarse or unusual. The goal is to
always match the patient with the smallest trach possible.<o:p></o:p></span></div>
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Ways to
Achieve Vocalization with a Tracheostomy<o:p></o:p></span></h1>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Covering the
tube<o:p></o:p></span></h2>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">Having the patient cover the tube by holding a finger or placing
a cap over the tube for short periods of time can be considered a
solution. This may, however, cause increased resistance to breathing that
is intolerable to some patients. Contaminants from the hand or fingers may
introduce infection into the body, a particularly critical problem for patients
with aspiration problems. Some patients may get enough air for speech
without blocking the tube, but may not have the awareness, muscle movement or
muscle tone to make a good occlusion.<o:p></o:p></span></div>
<h2 style="background: white;">
<span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; font-weight: normal; line-height: 115%;">Talking/Speaking/Speech
Valves<o:p></o:p></span></h2>
<br />
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">As an alternative, a variety of valves are available that can be
attached to the tracheostomy tube. These valves allow air to enter via the
tube, and exit through the mouth and nose. Use of certain valves is also
reported to have secondary benefits of reducing secretions, increasing the
sense of smell, reducing aspiration, facilitating decannulation (tube removal)
in patients for whom tracheostomy is not permanent, and increasing oxygenation
of blood in the arteries. Because all valves do not produce the same quality of
speech or the same secondary benefits, a valve for a specific patient should be
selected based on the scientific and clinical results.<o:p></o:p></span></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-42285682531913273952015-10-03T06:04:00.000-07:002015-10-03T06:07:24.678-07:00Types of Tracheostomy Tubes<div dir="ltr" style="text-align: left;" trbidi="on">
<div>
<h1 style="background: white; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 7.5pt; margin-right: 0in; margin-top: 0in;">
<span style="color: #0b2972; font-family: "Arial","sans-serif"; font-size: 15.0pt; line-height: 115%;">Types of
Tracheostomy Tubes<o:p></o:p></span></h1>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">A<span class="apple-converted-space"> tracheostomy</span><span class="apple-converted-space"> </span>(trach) tube is a curved tube that is
inserted into a tracheostomy<span class="apple-converted-space"> stoma</span><span class="apple-converted-space"> </span>(the hole made in the neck and
windpipe (Trachea)). There are different types of tracheostomy tubes that vary
in certain features for different purposes. These are manufactured by
different companies. However, a specific type of tracheostomy tube will
be the same no matter which company manufactures them.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">A commonly used tracheostomy tube consists of three parts:
outer<span class="apple-converted-space"> cannula</span><span class="apple-converted-space"> </span>with flange (neck plate), inner
cannula, and an<span class="apple-converted-space"> obturator</span>.
The outer cannula is the outer tube that holds the tracheostomy open. A neck
plate extends from the sides of the outer tube and has holes to attach cloth
ties or velcro strap around the neck. The inner cannula fits inside the outer
cannula. It has a lock to keep it from being coughed out, and it is removed for
cleaning. The obturator is used to insert a tracheostomy tube. It fits
inside the tube to provide a smooth surface that guides the<span class="apple-converted-space"> tracheostomy </span>tube
when it is being inserted.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
<span style="color: #4a4a4a; font-family: "Arial","sans-serif"; font-size: 9.0pt;">There are different types of tracheostomy tubes available and
the patient should be given the tube that best suits his/her needs. The
frequency of these tube changes will depend on the type of tube and may
possibly alter during the winter or summer months. Practitioners should refer
to specialist practitioners and/or the manufacturers for advice. <o:p></o:p></span></div>
</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border: solid black 1.0pt; mso-border-alt: solid black .75pt; mso-cellspacing: 0in; mso-padding-alt: 3.75pt 3.75pt 3.75pt 3.75pt; mso-yfti-tbllook: 1184; width: 100%px;">
<tbody>
<tr>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 11.25pt;" width="15"><div align="center" class="MsoNormal" style="text-align: center;">
<span class="header2"><span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; line-height: 115%;">Tube</span></span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 2.5in;" width="240"><div class="MsoNormal">
<span class="header2"><span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; line-height: 115%;">Indication</span></span><span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt;"><div class="MsoNormal">
<span class="header2"><span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; line-height: 115%;">Recommendations</span></span><span style="color: #4c689a; font-family: "Arial","sans-serif"; font-size: 13.5pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td colspan="3" style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 100.0%;" width="100%"><div class="MsoNormal">
<span class="header3"><b><span style="color: #4a4a4a; font-family: "Arial","sans-serif";">CuffedTube with Disposable Inner Cannula</span></b></span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 11.25pt;" width="15"><div align="center" class="MsoNormal" style="text-align: center;">
<img src="http://www.hopkinsmedicine.org/tracheostomy/images/Tubes/tube1.jpg" height="150" width="200" /></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 225.0pt;" width="300"><div class="MsoNormal">
Used to obtain a closed circuit for ventilation<span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 262.5pt;" width="350"><div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Cuff should be inflated when using with ventilators. </div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Cuff should be inflated just enough to allow minimal airleak.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Cuff should be deflated if patient uses a speaking valve.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Cuff pressure should be checked twice a day.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Inner cannula is disposable.</div>
</td>
</tr>
<tr>
<td colspan="3" style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 100.0%;" width="100%"><div class="MsoNormal">
<span class="header3"><b><span style="color: #4a4a4a; font-family: "Arial","sans-serif";"> Cuffed Tube with Reusable Inner Cannula</span></b></span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 11.25pt;" width="15"><div align="center" class="MsoNormal" style="text-align: center;">
<img src="http://www.hopkinsmedicine.org/tracheostomy/images/Tubes/tube2.jpg" height="150" width="200" /></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 225.0pt;" width="300"><div class="MsoNormal">
Used to obtain a closed circuit for ventilation<span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 262.5pt;" width="350"><div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Cuff should be inflated when using with ventilators. </div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Cuff should be inflated just enough to allow minimal airleak.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Cuff should be deflated if patient uses a speaking valve.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Cuff pressure should be checked twice a day.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Inner cannula is not disposable. You can reuse it after cleaning
it thoroughly.</div>
</td>
</tr>
<tr>
<td colspan="3" style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 100.0%;" width="100%"><div class="MsoNormal">
<span class="header3"><b><span style="color: #4a4a4a; font-family: "Arial","sans-serif";">Cuffless Tube with Disposable Inner Cannula</span></b></span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 11.25pt;" width="15"><div align="center" class="MsoNormal" style="text-align: center;">
<img src="http://www.hopkinsmedicine.org/tracheostomy/images/Tubes/tube3.jpg" height="150" width="200" /></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 225.0pt;" width="300"><div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Used for patients with tracheal problems</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Used for patients who are ready for decannulation</div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 262.5pt;" width="350"><div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Save the decannulation plug if the patient is close to getting
decannulated.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Patient may be able to eat and may be able to talk without a speaking
valve.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Inner cannula is disposable</div>
</td>
</tr>
<tr>
<td colspan="3" style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 100.0%;" width="100%"><div class="MsoNormal">
<span class="header3"><b><span style="color: #4a4a4a; font-family: "Arial","sans-serif";">Cuffed Tube with Reusable Inner Cannula</span></b></span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 11.25pt;" width="15"><div align="center" class="MsoNormal" style="text-align: center;">
<img src="http://www.hopkinsmedicine.org/tracheostomy/images/Tubes/tube4.jpg" height="150" width="200" /></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 225.0pt;" width="300"><div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Used for patients with tracheal problems</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Used for patients who are ready for decannulation</div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 262.5pt;" width="350"><div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Save the decannulation plug if the patient is close to getting
decannulated.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Patient may be able to eat and may be able to speak without a
speaking valve.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Inner cannula is not disposable. You can reuse it after cleaning it
thoroughly.</div>
</td>
</tr>
<tr>
<td colspan="3" style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 100.0%;" width="100%"><div class="MsoNormal">
<span class="header3"><b><span style="color: #4a4a4a; font-family: "Arial","sans-serif";">Fenestrated Cuffed Tracheostomy Tube</span></b></span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 11.25pt;" width="15"><div align="center" class="MsoNormal" style="text-align: center;">
<img src="http://www.hopkinsmedicine.org/tracheostomy/images/Tubes/tube5.jpg" height="150" width="200" /></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 225.0pt;" width="300"><div class="MsoNormal">
Used for patients who are on the ventilator but are not
able to tolerate a speaking valve to speak<span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 262.5pt;" width="350"><div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
There is a high risk for granuloma formation at the site of the fenestration
(hole).</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
There is a higher risk for aspirating secretions.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
It may be difficult to ventilate the patient adequately.</div>
</td>
</tr>
<tr>
<td colspan="3" style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 100.0%;" width="100%"><div class="MsoNormal">
<span class="header3"><b><span style="color: #4a4a4a; font-family: "Arial","sans-serif";">Fenestrated Cuffless Tracheostomy Tube</span></b></span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 11.25pt;" width="15"><div align="center" class="MsoNormal" style="text-align: center;">
<img src="http://www.hopkinsmedicine.org/tracheostomy/images/Tubes/tube6.jpg" height="150" width="200" /></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 225.0pt;" width="300"><div class="MsoNormal">
Used for patients who have difficulty using a speaking
valve<span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 262.5pt;" width="350"><div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
There is a high risk for granuloma formation at the site of the
fenestration (hole).</div>
</td>
</tr>
<tr>
<td colspan="3" style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 100.0%;" width="100%"><div class="MsoNormal">
<span class="header3"><b><span style="color: #4a4a4a; font-family: "Arial","sans-serif";">Metal Tracheostomy Tube</span></b></span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 11.25pt;" width="15"><div align="center" class="MsoNormal" style="text-align: center;">
<img src="http://www.hopkinsmedicine.org/tracheostomy/images/Tubes/tube7.jpg" height="150" width="200" /></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 225.0pt;" width="300"><div class="MsoNormal">
Not used as frequently anymore. Many of the patients
who received a tracheostomy years ago still choose to continue using the
metal tracheostomy tubes.<span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
<td style="border: inset black 1.0pt; mso-border-alt: inset black .75pt; padding: 3.75pt 3.75pt 3.75pt 3.75pt; width: 262.5pt;" width="350"><div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
Patients cannot get a MRI.</div>
<div style="margin-bottom: 17.4pt; margin-left: 0in; margin-right: 0in; margin-top: 3.0pt;">
One needs to notify the security personnel at the airport prior to metal
detection screening.</div>
</td>
</tr>
</tbody></table>
</div>
<div>
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<div>
<br /></div>
<div>
Source - http://www.hopkinsmedicine.org/tracheostomy</div>
<div>
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<div>
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</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-82154226241658447372015-10-03T05:14:00.000-07:002015-10-03T05:15:28.409-07:00Tracheostomy care<div dir="ltr" style="text-align: left;" trbidi="on">
<h1 style="background: white; margin-top: 0in; mso-line-height-alt: 12.0pt; vertical-align: baseline;">
<span style="color: #404040; font-family: "Times New Roman","serif"; font-size: 18.0pt;">Tracheostomy care<o:p></o:p></span></h1>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">A tracheostomy is surgery to make a hole
in the neck that goes into windpipe. <o:p></o:p></span></div>
<div style="margin-bottom: .2in; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-size: 10.5pt;">A tracheostomy is an artificial opening in the
trachea, usually between the 3rd and 4th tracheal rings into which a tube is
inserted and through which tube the person breathes. A tracheostomy is
initially a life-</span><strong><span style="font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">saving</span></strong><span class="apple-converted-space"><span style="font-size: 10.5pt;"> </span></span><span style="font-size: 10.5pt;">operation but is also a life-</span><strong><span style="font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">threatening</span></strong><span class="apple-converted-space"><span style="font-size: 10.5pt;"> </span></span><span style="font-size: 10.5pt;">one
unless the airway is kept clear from secretions and blockages 24 hours a day. <span style="color: #444444;">If one need it for just a short time, it will be closed
later. Some people need the hole for the rest of their life.<o:p></o:p></span></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">The hole is needed when the airway is
blocked or for some conditions that make it hard for one to breathe. Some may need a tracheostomy if he/she is on a
breathing machine (ventilator) for a long time.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">After the hole is made, a plastic tube
is placed in the hole to keep it open. A ribbon is tied around the neck to keep
the tube in place.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">The surgery is done in the hospital. Before
leaving the hospital one should be able
to:<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Clean, replace, and suction the tube<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Keep the air you breathe moist<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Clean the hole with water and mild soap or hydrogen peroxide<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Change the dressing around the hole<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">DO NOT do strenuous activity or
hard exercise for 6 weeks after surgery. After the surgery, you may not be able
to speak. Ask your doctor for a referral to a speech therapist to help you
learn to talk with your tracheostomy. This is usually possible once your
condition improves.<o:p></o:p></span></div>
<h2 style="background: white; line-height: 18.65pt; margin-top: 0in; vertical-align: baseline;">
<span style="color: #404040; font-family: "Times New Roman","serif"; font-size: 13.5pt;">Self-care<o:p></o:p></span></h2>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">You will have a small amount of mucus
around the tube. This is normal. The hole in your neck should be pink and
painless.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">It is important to keep the tube free of
thick mucus. You should always carry an extra tube with you in case your tube
gets plugged. Once you put in the new tube, clean the old one and keep it with
you as your extra tube.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">When you cough, have a tissue or cloth
ready to catch the mucus coming from your tube.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">Your nose will no longer keep the air
you breathe moist. Talk with your doctor about how to keep the air you breathe
moist and how to prevent plugs in your tube.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">Some common ways to keep the air you
breathe moist are:<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo2; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Putting a wet gauze or cloth over the outside of your tube. Keep
it moist.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo2; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Using a humidifier in your home when the heater is on and the
air is dry<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">A few drops of salt water (saline) will
loosen a plug of thick mucus. Put a few drops in your tube and windpipe, then
take a deep breath and cough to help bring up the mucus.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">Protect the hole in your neck with a
cloth or tracheostomy cover when you go outside. These covers can also help
keep your clothes clean from mucus and make your breathing sounds quieter.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">DO NOT breathe in water, food,
powder, or dust. When you take a shower, cover the hole with a tracheostomy
cover. You will not be able to go swimming.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">To speak, you will need to cover the
hole with your finger, a cap, or a speaking valve.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">Sometimes you can cap the tube. Then you
might be able to speak normally and breathe through your nose and mouth.<o:p></o:p></span></div>
<h2 style="background: white; line-height: 18.65pt; margin-top: 0in; vertical-align: baseline;">
<span style="color: #404040; font-family: "Times New Roman","serif"; font-size: 13.5pt;">Caring for Your Tracheostomy<o:p></o:p></span></h2>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">Once the hole in your neck is not sore
from the surgery, clean the hole with a cotton swab or a cotton ball
at least once a day to prevent infection.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">The bandage (gauze dressing) between
your tube and neck helps catch mucus. It also keeps your tube from rubbing on
your neck. Change the bandage when it is dirty, at least once a day.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">Change the ribbons (trach ties) that
keep your tube in place if they get dirty. Make sure you hold the tube in place
when you change the ribbon. Be sure you can fit 2 fingers under the ribbon to
make sure it is not too tight.<o:p></o:p></span></div>
<h2 style="background: white; line-height: 18.65pt; margin-top: 0in; vertical-align: baseline;">
<span style="color: #404040; font-family: "Times New Roman","serif"; font-size: 13.5pt;">When to Call the Doctor<o:p></o:p></span></h2>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">Call your doctor if you have:<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo3; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Fever or chills<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo3; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Redness, swelling, or pain that is getting worse<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo3; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Bleeding or drainage from the hole<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo3; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Cough or shortness of breath, even after you suction your tube<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo3; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Nausea or vomiting<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.4pt; margin-bottom: 10.3pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo3; tab-stops: list .5in; text-indent: -.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #444444; font-family: "Times New Roman","serif"; font-size: 10.5pt;">Any new or unusual symptoms<o:p></o:p></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: 17.15pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; vertical-align: baseline;">
<span style="color: #444444; font-size: 10.5pt;">Call your local emergency number if your
tracheostomy tube falls out and you cannot replace it.<o:p></o:p></span><br />
<span style="color: #444444; font-size: 10.5pt;"><br /></span>
<span style="color: #444444; font-size: 10.5pt;">www.icancare.org</span></div>
<br />
<div class="MsoNormal">
<br /></div>
</div>
Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-71461376480304748022015-09-21T16:18:00.000-07:002015-09-24T16:00:51.788-07:00Choosing the External Breast Prosthesis (Form) after Mastectomy<div dir="ltr" style="text-align: left;" trbidi="on">
<div align="center" class="MsoNormal" style="text-align: center;">
<b><u>Choosing the <a href="http://www.icancare.org/" target="_blank">External Breast Prosthesis (Form)</a> after Mastectomy<o:p></o:p></u></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><u><br /></u></b></div>
<div class="MsoNormal">
In the Chart below<o:p></o:p></div>
<div class="MsoNormal">
-Choose the cup size<o:p></o:p></div>
<div class="MsoNormal">
- Follow the row horizontally, to find the bra band size<o:p></o:p></div>
<div class="MsoNormal">
- Follow this column
vertically down to <a href="http://www.icancare.org/mastectomy-products" target="_blank">the breast form (external Prosthesis)</a>, the number in this
square gives you the prosthesis size.<o:p></o:p></div>
<div class="MsoNormal">
- This is a guide for the size of <a href="http://www.icancare.org/mastectomy-products" target="_blank">external prosthesis</a>,
however for a perfect fit a size up or down may be needed<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr>
<td style="background: yellow; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Cup Size<o:p></o:p></b></div>
</td>
<td colspan="18" style="background: #00B0F0; border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 5.5in;" valign="top" width="528"><div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;">
<b>Band Size<o:p></o:p></b></div>
</td>
</tr>
<tr>
<td style="background: yellow; border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">AA<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
30<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
32<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
34<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
38<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
40<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
42<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
</tr>
<tr>
<td style="background: yellow; border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">A<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
30<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
32<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
34<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
38<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
40<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
42<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
44<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
46<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
</tr>
<tr>
<td style="background: yellow; border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">B<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
30<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
32<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
34<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
38<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
40<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
42<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
44<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
46<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
48<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
50<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
52<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
</tr>
<tr>
<td style="background: yellow; border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">C<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
32<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
34<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
38<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
40<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
42<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
44<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
46<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
48<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
50<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
52<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
</tr>
<tr>
<td style="background: yellow; border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">D<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
32<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
34<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
38<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
40<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
42<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
44<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
46<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
48<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
50<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
52<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
</tr>
<tr>
<td style="background: yellow; border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">DD<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
32<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
34<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
38<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
40<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
42<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
44<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
46<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
48<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
50<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
52<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
</tr>
<tr>
<td style="background: yellow; border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">DDD<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
32<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
34<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
38<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
40<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
42<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
44<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
46<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
48<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
50<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
52<o:p></o:p></div>
</td>
</tr>
<tr>
<td style="background: yellow; border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">G<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
32<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
34<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
38<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
40<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
42<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
44<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
46<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
48<o:p></o:p></div>
</td>
</tr>
<tr>
<td style="background: yellow; border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">H<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 22.0pt;" valign="top" width="29"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
32<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
34<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
36<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
38<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
40<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
42<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
44<o:p></o:p></div>
</td>
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46<o:p></o:p></div>
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<b><a href="http://www.icancare.org/mastectomy-products" target="_blank">Breast Form (External Breast Prosthesis) Size</a><o:p></o:p></b></div>
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0<o:p></o:p></div>
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1<o:p></o:p></div>
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2<o:p></o:p></div>
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3<o:p></o:p></div>
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4<o:p></o:p></div>
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5<o:p></o:p></div>
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6<o:p></o:p></div>
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7<o:p></o:p></div>
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8<o:p></o:p></div>
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9<o:p></o:p></div>
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10<o:p></o:p></div>
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11<o:p></o:p></div>
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12<o:p></o:p></div>
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13<o:p></o:p></div>
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14<o:p></o:p></div>
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15<o:p></o:p></div>
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16<o:p></o:p></div>
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17<o:p></o:p></div>
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<a href="http://www.icancare.org/">www.icancare.org</a><br />
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Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-86943214749238984932015-08-03T15:52:00.000-07:002015-08-03T15:52:13.122-07:00Cancer Survival Rates<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="color: #990000; font-family: verdana; font-size: 14px; padding: 5px;">
<strong>Cancer survival rates, how to interprete</strong></div>
<div style="float: left; font-size: 12px; padding: 5px; text-align: justify;">
<span style="font-family: Verdana, Arial, Helvetica, sans-serif;">One of the first questions many people ask when first diagnosed with cancer is about their prognosis. They might want to know whether the cancer is relatively easy or more difficult to cure. The doctor cannot predict the future, but often he/she gives the estimates based on the experiences of other people with the same cancer. Survival statistics can be confusing and frightening. Survival rates cannot tell about the situation specifically. The statistics may be impersonal and not very helpful.</span><br /><br /><span style="font-family: Verdana, Arial, Helvetica, sans-serif;">Cancer survival rates or survival statistics indicate the percentage of people who survive a certain type of cancer for a specific amount of time. Cancer statistics often use a five–year survival rate. For instance, the five–year survival rate for prostate cancer is 99 percent. That means that of all men diagnosed with prostate cancer, 99 of every 100 lived for five years after diagnosis. Conversely, one out of every 100 will die of prostate cancer within five years.</span><br /><br /><span style="font-family: Verdana, Arial, Helvetica, sans-serif;">Cancer survival rates are based on research that comes from information gathered on hundreds or thousands of people with cancer. An overall survival rate includes people of all ages and health conditions diagnosed with the cancer, including those diagnosed very early and those diagnosed very late. Only the treating doctor may be able to give more specific statistics based on the stage of cancer. For instance, 49 percent, or about half, of people diagnosed with early–stage lung cancer live for at least five years after diagnosis. The five–year survival rate for people diagnosed with lung cancer that has spread (metastasized) to other areas of the body is 2 percent. Overall and relative survival rates do not specify whether cancer survivors are still undergoing treatment at five years or if they’ve become cancer free (achieved remission). The five year survival rates for all men is 47.3–66%% and for all women is 55.8–63%</span><br /><br /><strong style="font-family: Verdana, Arial, Helvetica, sans-serif;">Other terms</strong><ul style="font-family: verdana;">
<li style="margin-left: 15px;">Disease–free survival rate. This is the number of people with cancer who achieve remission. That means they no longer have signs of cancer in their bodies.</li>
<li style="margin-left: 15px;">Progression–free survival rate. This is the number of people who still have cancer, but their disease isn’t progressing. This includes people who may have had some success with treatment, but their cancer hasn’t disappeared completely.</li>
</ul>
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<span style="font-family: verdana;"><br /></span></div>
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<span style="font-family: verdana;">(Emedinews, August 4th)</span></div>
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Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-5386645610368798462015-05-05T14:25:00.000-07:002015-09-21T16:32:19.418-07:00MOTTO of Innovative Cancer Care and Rehabilitation TO HELP AND NOT TO SELL!<div dir="ltr" style="text-align: left;" trbidi="on">
<h3 class="post-title entry-title" itemprop="name" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 22px; font-stretch: normal; font-weight: normal; margin: 0.75em 0px 0px; position: relative;">
MOTTO of Innovative Cancer Care and Rehabilitation</h3>
<div class="post-header" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 10.8000001907349px; line-height: 1.6; margin: 0px 0px 1.5em;">
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<div class="post-body entry-content" id="post-body-4344754435365106243" itemprop="description articleBody" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.1999998092651px; line-height: 1.4; position: relative; width: 570px;">
<div dir="ltr" trbidi="on">
TO HELP AND NOT TO SELL!</div>
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Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-65835129965502754392015-05-05T14:23:00.002-07:002015-05-05T14:23:47.163-07:00Post Mastectomy - How to Measure for a Proper Fit<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal" style="margin-bottom: 7.5pt; mso-line-height-alt: 12.0pt; mso-outline-level: 1;">
<b>Post Mastectomy - How to Measure for a Proper Fit<o:p></o:p></b></div>
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<b><span style="font-family: Verdana, sans-serif; font-size: 10pt;">Proper Bra Size:</span></b><span style="font-family: Verdana, sans-serif; font-size: 10pt;"><br />Place tape measure under breast from center of breastbone in front to center of spine in back. Double the measurement and add 5 inches. This is your bra size. Example: If under breast measurement (center front to center back) is 14 1/2 inches, double it (14 1/2 x 2 = 29 inches). Add 5 inches. Your bra size would be 34 inches. Note: if total is an odd number (35 for example) select the next larger size (for 35, buy 36).<o:p></o:p></span></div>
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<b><span style="font-family: Verdana, sans-serif; font-size: 10pt;"><br /></span></b></div>
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<b><span style="font-family: Verdana, sans-serif; font-size: 10pt;">Proper Cup Size:</span></b></div>
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<span style="font-family: Verdana, sans-serif; font-size: 10pt;">Measure over fullest part of remaining breast from center breastbone in front to center of spine in back. Double the number. If measurement is the same as the bra size determined above, or up to 1 inch more, order A cup; if 2 to 3 inches more, order B cup; if 3 to 4 inches more, order C cup; if 4 to 5 inches more, order D cup; if 5 to 6 inches more, order DD cup.<o:p></o:p></span></div>
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<b><span style="font-family: Verdana, sans-serif; font-size: 10pt;">Cup Size for Double Mastectomy:</span></b><span style="font-family: Verdana, sans-serif; font-size: 10pt;"><br />Cup size is the same as that worn prior to surgery. If you want to be larger or smaller, select one size above or below your previous size.<o:p></o:p></span></div>
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<span style="font-family: Verdana, sans-serif; font-size: 10pt;">Alternatively</span></div>
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<span style="font-family: Verdana, sans-serif; font-size: 10pt;">You can measure the bra size by meauring below bust and shoulder blade and adding 5 inches. the cup size is the one that you were wearing earlier.</span></div>
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Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-87990679053839604352015-05-05T14:22:00.000-07:002015-09-21T16:37:59.468-07:00How to Select a Bra that Fits<div dir="ltr" style="text-align: left;" trbidi="on">
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How to Select a Bra that Fits</div>
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All women lose firmness as we get older, and so do our bras. When you buy a bra, try to make sure it fits you in the loosest hook. That way you can tighten the bra to the second and third hooks as it ages and still get the firmness and the lift.<br />
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Ideally, your breasts/breast forms should be midway between your shoulders and your elbows. Your bra should be level from front to back. Most women wear their bra bands too high on their torsos and this throws the fit off.<br />
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Another frequent mistake is to increase the band size, instead of getting a deeper cup. The bra needs to be snug in the back to lift the bust. The bra band is like a bridge; if it is properly placed, snug and lower at the base, it can lift and support better.<br />
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Remember to bend deeply at the waist before fastening your bra. This automatically centers it and distributes the volume of your breasts/breast forms evenly. The straps should neither fall down nor dig into your shoulders. They ought to provide only 10% of the bra’s support; the rest comes from the band.<br />
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In order for your bra to keep its shape and support, change bras throughout the week. If you wear the same bra two days in a row you will wear out the support elastic so that it loses its memory.<br />
Here are some clues that your bra is the wrong size:<br />
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<li>If your breast spills over the cup, it's time to go up a cup size.</li>
<li>If your breast form doesn’t fill the cup, matching the natural side, you need a larger size form. The measurement from nipple to bottom band should be the same on both sides.</li>
<li>If your cups dimple, it's time to go down a cup size.</li>
<li>If you have a roll of fat showing in back, you probably think your bra is too tight but, in fact, your bra is too large. Wearing the bra lower on your back with a smaller band size will eliminate the back fat.</li>
<li>If your straps fall down, your bra band is riding up and you probably need to go down a band size.</li>
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Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com1tag:blogger.com,1999:blog-6555521123884504091.post-53089066944855872202015-05-05T14:20:00.000-07:002015-05-05T14:20:44.264-07:00LYMPHEDEMA PRECAUTIONS<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span lang="EN-US" style="font-size: 18.0pt; mso-bidi-font-size: 12.0pt;">LYMPHEDEMA PRECAUTIONS<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">Lymphedema is swelling of the arm on the side of surgery as consequences of removal of lymph nodes from the arm pit. Prevention of lymphedema is highly desirable as it is quite resistant to treatment. It can happen to about 15-20% of people who underge surgery for breast cancer & can set in weeks, months or years after surgery.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">Precaution to be taken:<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">Avoid pricks and needles on the arm on the operated side.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-family: "Agra Thin"; font-size: 14pt;">vius izHkkfor gkFkksa dks lwbZ rFkk [kjksap ls cpk;sa A<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">Blood pressure measurement should be avoided on the side of surgery.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-family: "Agra Thin"; font-size: 14pt;">vkWijs’ku dh rjQ okys gkFk ls jDr pki dh tkWp u djsa A<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">Heavy weights more than 5kg should not be lifted by the arm on the operated side .<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-family: "Agra Thin"; font-size: 14pt;">vkWijs’ku dh rjQ okys gkFk ls 5 fdxzk ls vf?kd dk out u mBk,a A</span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">Cuts, stings, insect bite should be avoided.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">Tight garments, bracelets & rings should not be worn on the affected side.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-family: "Agra Thin"; font-size: 14pt;">Rakx diMs] dMs rFkk vWxwBh dks</span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;"> </span><span lang="EN-US" style="font-family: "Agra Thin"; font-size: 14pt;">vkWijs’ku dh rjQ okys gkFk esa u igusa A</span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">Be careful while paring your nails, Avoid waxing of the arm on the affected side.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-family: "Agra Thin"; font-size: 14pt;">Ukk[kqu dkVrs le; lko/kuh cjrsa rFkk izHkkfor gkFzkks dh rjQ ckyks dj lQkbZ djrs le; lko/kkuh cjrsa A<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">In case of any accidental cuts, wash the wound carefully and apply antiseptic ointment a once.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-family: "Agra Thin"; font-size: 14pt;">;fn fdlh nq?kZVuko’k dgha dV tk, rks mls lko/kkuh ls lkQ djds ,UVhlsIfVd dzhe yxk;sa A<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">If there is redness or swelling in the arm, report back immediately to your treating physician.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-family: "Agra Thin"; font-size: 14pt;">;fn cktq esa dgha yky fu’kku ;k lwtu gks rks rqjUr vius fpfdRld dks lwfpr djsa A<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">If you intend to fly, please ensure that your wear a custom made sleeve for the arm on the operated side.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">If you wish to undertake a trip by flight, kindly ensure you have an arm sleeve (custom made) on during the duration of the flight. Information regarding the same will be provided to you at the hospital.</span></div>
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Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0tag:blogger.com,1999:blog-6555521123884504091.post-18408171064794305972015-05-05T14:18:00.000-07:002015-09-21T16:30:18.618-07:00Drain Care<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span lang="EN-US" style="font-size: 20.0pt; mso-bidi-font-size: 12.0pt;">Drain Care<o:p></o:p></span></b></div>
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<span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US">Wash your hands carefully before handling the drainage system.<o:p></o:p></span></div>
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<span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US">Close the stopper and</span> uncork the tube from the ringed collection box.</div>
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<span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US">Measure the fluid in the collection box. Empty </span>the collection box by inverting it and shaking the content out at 8 a.m. (any fixed time) in the morning. Please do not wash the box.</div>
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<span lang="EN-US"> <o:p></o:p></span></div>
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<span lang="EN-US">4.<span style="font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US">Measure the amount of fluid collected between 8 a.m. the previous day to 8 a.m. the next day<o:p></o:p></span></div>
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<span lang="EN-US">5.<span style="font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US">After emptying the box, reconnect the tube to the box by closing the cork. Press the rings firmly down before applying the cork. Now release the stopper.</span></div>
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<span lang="EN-US">6.<span style="font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US">Please make sure that the connectors are secure firmly to the tubes coming out from the operation site. If there is only one tube coming out from the operation site, please ensure that the other connector is closed with its stopper.</span></div>
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<span lang="EN-US">7.<span style="font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US">If there is any leakage from the side of the tube or if the collection box cannot be completely pressed down despite application of appropriate pressure, please report to your treating doctor.</span></div>
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<span lang="EN-US">8.<span style="font-size: 7pt; font-stretch: normal;"> </span></span><span lang="EN-US">Clots can block your tubes and this can cause fluid to escape from the sides of the tube. If this happens, consult your physician immediately. This is a commonly encountered problem. Corrective measures involve removal of clot and restoration of flow through the tube.<o:p></o:p></span></div>
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Pawan Guptahttp://www.blogger.com/profile/02256556012683270503noreply@blogger.com0