Tracheostomy care a clinical teaching

1. TRACHEOSTOMY CARE
PREPARED BY:
ANVIN THOMAS
MSC nursing

2. Tracheostomy
• It is a surgical opening in the anterior wall of
the trachea just below the larynx.

4. Identifying Tracheostomy Parts

6. INDICATIONS:-
• To provide and maintain patent airway.
• To enable the removal of tracheo-bronchial
secretions.
• provide mechanical ventilation on a long-term basis
as in cases of neuromuscular disease
• As preparation for extensive head and neck procedure.
• To bypass obstruction: Cancer larynx

7. Continue…
• To remove secretions more easily:
Inability to swallow or cough: stroke patient
• To improve patient comfort.
• To decrease the work of breathing and
increase volume of air entering the lungs

8. TYPES OF TRACHEOSTOMY
TUBES
• Plastic or metal
• Cuffed or uncuffed
• Fenestrated or unfenestrated
• Double canula or single canula

9. TYPES OF TRACHEOSTOMY
TUBE
• PLASTIC
• METAL

10. TYPES OF TRACHEOSTOMY
TUBES
• CUFFED
• UNCUFFED

11. TYPES OF TRACHEOSTOMY
TUBE
FENESTRATED
UNFENESTRATED

12. TYPES OF TRACHEOSTOMY
TUBES
• SINGLE CANULA
• DOUBLE CANULA

13. ANATOMICAL POSITIONING OF
TRACHEOSTOMY TUBE

14. COMPLICATIONS
• Immediate
1. Hemorrhage
2. Hypoxia
3. Trauma to recurrent laryngeal nerve
4. Damage to esophagus
5. Pneumothorax
6. Infection
7. Subcutaneous emphysema

15. COMPLICATIONS
• Early
1. Tube obstruction or displacement
2. Pooling of secretions leading to aspiration
and LRTI
3. Bleeding from tracheostomy site
4. Infection

16. COMPLICATIONS
• Late
1. Airway obstruction with aspiration
2. Damage to larynx. Eg. Stenosis
3. Tracheal stenosis
4. Tracheomalacia
5. Aspiration and pneumonia
6. Fistula formation .eg. Tracheo- cutaneous or
tracheo-oesopheal

17. Potential short-term complications
• Subcutaneous emphysema
– air escapes around stoma ; generally of no
clinical consequence –can be palpated around
the stoma site

18. Potential short-term complications
• Dislodgement of the tube
Due to excessive manipulation of the
tracheostomy tube during coughing or
suctioning– (more in the first 48 hours)

19. Potential long-term complications
Tracheostomy:
Thinning of the trachea
(Trachemalacia)

20. Potential long-term complications
Tracheostomy
• Development of granulation of tissue (bump
formation in trachea

21. Potential long-term complications
Tracheostomy:
• Narrowing of the airway above the site of
tracheostomy

22. 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}

23. 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}

24. Suctioning
• Place patient in semi-fowler’s position
• Hyper oxygenate BEFORE each suction pass
(except patients with long-term tracheostomy)
• Insert catheter to a pre-measured depth
• Apply suction on withdrawal of catheter
• Limit suctioning to 10 seconds
• Use suction pressure between 80 – 120 mmHg
• Discontinue if HR drops by 20; increases by 40,
produces arrhythmias, or decreases 02 < 90%

25. 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 hydrated- otherwise
secretion will become thicker and will lead
to infection.

26. THINGS TO REMEMBER
• WHEN IN DOUBT CHANGE IT OUT
• DON’T PANIC
• STERILE TECHNIQUE
• SAFTEY FIRST
• CRITICAL THINKING
• NUTRITION
• COMMUNICATION