MEDICAL AND SURGICAL NURSING TRACHEOSTOMY CARE Lecturer: Mark Fredderick R. Abejo RN,MAN __________________________________________________ TRACHEOSTOMY A surgical insicion in the trachea just belowthe larynx. A curved tracheostomy tube is inserted toextend through the stoma into the trachea. Tracheostomy Tube in Place Clients who need long-term airway support.
Lecture Notes on Tracheostomy CarePrepared By: Mark Fredderick R Abejo R.N, M.A.N Clinical Instructor Tracheostomy tubes have an outer cannula that Assessment: is inserted into trachea and a flange that rests Assess against the neck and allows the tube to be Respiratory status secured in place with tape or ties. Pulse rate Obturator is kept at the client’s bedside in Character and amount of secretions from case the tubes tracheostomy site Presence of drainage Appearance of incision Steps / Procedure Rationale Identify and inform the client and explain To allay anxiety the procedure. Wash hands and observe other appropriate infection control procedure Cuffed tracheostomy tubes are surrounded by Assist the client to a an inflatable cuff that produce an airtight seal semi-Fowler’s or To promote lung between the tube and the trachea. Fowlers position expansion This seal prevents aspiration of orophrayngeal Prepare the secretions and air leakage between the tube and equipment, open the the trachea. tracheostomy kit. Pour hydrogen peroxide intoProviding Tracheostomy Care separate container Establish a sterilePurposes field, open other To maintain airway patency sterile supplies: To maintain cleanliness and prevent infection tracheostomy at the tracheostomy site dressing, suction To facilitate healing and prevent skin Suction the excoriation around tracheostomy incision tracheostomy tube To promote comfort After suctioning,NOTE: wrap the catheter Initially a tracheostomy may need to be around your hand andsuctioned as often as every 1 – 2 hours. After the peel the glove offinitial inflammatory response subsides, it may with the catheterdone once or twice a day. inside the glove and discardEquipment: Using the other Hydrogen peroxide- Sterile disposable tracheostomy cleaning kit gloved hand, unlock moisten and loosens- Towel the inner cannula (if dried secretions- Sterile suction kit present) and remove- Hydrogen peroxide and sterile normal saline it gently and place on- Sterile gloves the hydrogen- Clean gloves peroxide solution- Sterile 4 x 4 gauze dressing Remove the soiled- Cotton twill tracheostomy- Clean scissors dressing, place the soiled dressing in
Lecture Notes on Tracheostomy CarePrepared By: Mark Fredderick R Abejo R.N, M.A.N Clinical Instructor your gloved hand and peel the glove off with the soiled dressing and discard Put on another sterile gloves. Keep dominant hand sterile during the procedure. Clean the inner cannula: Remove the inner cannula from the soaking solution Clean the lumen and entire cannula thoroughly using a brush or pipe Tape and pad the tie knot. cleaners moistened Check the tightness of the ties. with sterile NSS Document all relevant information. Rinse the inner Rinsing is important to cannula thoroughly remove hydrogen in the sterile normal peroxide saline. Using sterile technique, suction the outer cannula. Replace the inner cannula, securing it in place: Insert the inner cannula by grasping the outer flange and inserting the cannula in the direction of its curvature. Lock the cannula in place by turning the lock (if present) into position to secure the flange of the inner cannula to the outer cannula. Clean the incision site and tube flange: Using sterile applicators or gauze dressings moistened with normal saline, clean the incision site. Handle the sterile supplies with your dominant hand. Use each applicator or gauze dressing only once and then discard. Hydrogen peroxide may be used to remove crustysecretions. Thoroughly rinse the cleaned area, using gauze squares moistened with sterile normal saline. Clean the flange of the tube in the same manner. Thoroughly dry the client’s skin and tube flanges with dry gauze squares.