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Tracheostomy care bitto

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Lecture PREPARED BY: …

Lecture PREPARED BY:
BITTO BABY
BSN,RN- Meeqat General Hospital, ICU.

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  • 1. TRACHEOSTOMY CARE PREPARED BY: BITTO BABY BSN,RN
  • 2. ANATOMY
  • 3. Tracheostomy It is a surgical opening in the anterior wall of the trachea just below the larynx.
  • 4. INDICATIONS:To provide and maintain patent airway. To enable the removal of tracheobronchial secretions. To permit long term positive pressure ventilation. To improve patient comfort. To decrease the work of breathing and increase volume of air entering the lungs
  • 5. TYPES OF TRACHEOSTOMY TUBES Plastic or metal Cuffed or uncuffed Fenestrated or unfenestrated Double canula or single canula
  • 6. TYPES OF TRACHEOSTOMY TUBE PLASTIC METAL
  • 7. TYPES OF TRACHEOSTOMY TUBES CUFFED UNCUFFED
  • 8. TYPES OF TRACHEOSTOMY TUBE FENESTRATED UNFENESTRATED
  • 9. TYPES OF TRACHEOSTOMY TUBES SINGLE CANULA DOUBLE CANULA
  • 10. SHILEY CUFFLESS FENESTRATED TRACHEOSTOMY TUBE
  • 11. ANATOMICAL POSITIONING OF TRACHEOSTOMY TUBE
  • 12. COMPLICATIONS 1. 2. 3. 4. 5. 6. 7. Immediate Hemorrhage Hypoxia Trauma to recurrent laryngeal nerve Damage to esophagus Pneumothorax Infection Subcutaneous emphysema
  • 13. COMPLICATIONS 1. 2. 3. 4. 5. Early Tube obstruction or displacement Pooling of secretions leading to aspiration and LRTI Aspiration Bleeding from tracheostomy site Infection
  • 14. COMPLICATIONS 1. 2. 3. 4. 5. 6. Late Airway obstruction with aspiration Damage to larynx. Eg. Stenosis Tracheal stenosis Tracheomalacia Aspiration and pneumonia Fistula formation .eg. Tracheocutaneous or tracheo-oesopheal
  • 15. CARE OF THE PATIENT WITH TRACHEOSTOMY Stoma care 1. Meticulous care towards hygiene and asepsis is necessary. 2. Remember the skin surrounding the stoma is also prone to irritation. 3. as per hospital policy}and barrier cream applied to the local skin{ cotton wool should be avoided}
  • 16. CARE OF THE PATIENT WITH TRACHEOSTOMY Tube care 1. Tubes need to be cleaned. 2. The area should be cleaned with normal saline {In double cannula the inner cannula will need to be removed and to be cleaned. {Usually just with warm water and then left to air dry} 3. For cuffed tracheostomy tubes the pressure should be measured in every shift{ as per hospital policy}and maintained between 15-30cm of water.
  • 17. CARE OF THE PATIENT WITH TRACHEOSTOMY Suctioning 1. Suctioning should be done PRN ,after chest PT and Nebulization 2. Use the lowest pressure needed ,usually less than 120 mmHg and definitely not beyond 200mmHg. 3. Suctioning should be performed less than 10seconds.
  • 18. CARE OF THE PATIENT WITH TRACHEOSTOMY Humidification 1. The normal humidification and air filtration system is bypassed if the tracheostomy is in situ 2. Keep patients well hydratedotherwise secretion will become thicker and will lead to infection.
  • 19. THINGS TO REMEMBER WHEN IN DOUBT CHANGE IT OUT DON’T PANIC STERILE TECHNIQUE SAFTEY FIRST CRITICAL THINKING NUTRITION COMMUNICATION
  • 20. CARE….IT INSPIRES AND GENTLY REASSURES !!!!