This document discusses tracheostomy care including what a tracheostomy is, types of tracheostomy tubes, nursing care of tracheostomy patients, changing tracheostomy tubes, and managing emergencies. A tracheostomy is a surgical procedure that places a tube in the trachea to bypass airway blockages or assist ventilation. There are different types of tracheostomy tubes including cuffed vs uncuffed and various materials. Nursing care involves hygiene, humidification, suction, and periodic cuff deflation. Tube changes are typically done every 1-4 weeks using sterile technique. Emergencies require prompt recognition and treatment to address causes like tube blockage, bleeding, or excessive secretions.

1. Tracheostomy Care
Dr. Mayank Kumar, MBBS, MS
Consultant ENT Surgeon

2. Tracheostomy Care
 What is a “Tracheostomy”?
 Types of Tracheostomy
 Types of Tracheostomy Tubes
 Physiological Changes due to Tracheostomy
 Nursing Care
 Changing of Tracheostomy Tube
 Emergencies & their Management
 Immediate/Early Postoperative Complications
 Late
 Decannulation & Stoma Closure

3. What is a “Tracheostomy”?
 A tracheostomy is a short surgical procedure in which an ENT surgeon places a
tube for breathing into the patient’s trachea (windpipe) in the neck.
 The reasons may include:
 bypassing a blockage in the upper airway,
 to assist patient who cannot cough out the mucus from their lungs (lower airway
toileting), and
 to aid a patient who needs to be on a ventilator for a long time.

4. What is a “Tracheostomy”?

5. Types of Tracheostomy
 Elective vs Emergency
 Temporary vs Permanent
 Open/Surgical vs Percutaneous/Dilatational

6. Types of Tracheostomy Tubes
 Disposable vs Reusable
 Metallic vs Non-metallic
 Single cannula vs Dual cannula
 Cuffed vs Cuffless/uncuffed/noncuffed/plain
 Adjustable flange vs Fixed length
 Solid vs Fenestrated
 Rigid vs Flexible
 With or without Suction port, etc.

7. Other Parameters
 Material
 Angulation
 Size
 Jackson sizing system
 International Standards Organization (ISO) sizing system:
Inner diameter of the outer tube
 Cuff – Low-pressure, high-volume
 Barrel-shaped
 Foam-type
 Tear-drop shaped

8. Brands
 Portex
 Shiley
 TRACOE
 Bivona
 Arcadia

9. Gunmetal Tubes
 Jackson’s Tube
 Outer cannula/tube
 Inner cannula/tube
 Obturator

10. Gunmetal Tubes
 Fuller’s Tube
 Outer bivalved/biflanged tube
 Inner fenestration tube

11. Portex Tracheostomy Tubes
 Smiths Medical
 Flexible thermosensitive polyvinyl chloride (PVC) with silicone coating
 Provides sufficient rigidity for initial insertion, and then softens at body temperature
to accommodate individual patient anatomy
 Obturator
 Suction Aid
 Blue Line

12. Portex Tracheostomy Tubes
 Plain tubes
 Cuffed tubes
 Cuffed tubes with suction port

13. Physiological Changes due to
Tracheostomy
 Loss of air conditioning – warming, moistening, filtering effects of nose
 Reduction in physiological dead space
 Loss of voice
 Loss of glottic hold (Inability to strain)

14. Nursing Care
 Call-bell
 Pen & paper
 Local hygiene – Keep dry – Stoma care
 Warm humidification
 Wet gauze
 Steam
 HME
 Suction
 Periodic cuff deflation

15. Suction
 Why?
 Excessive mucous
 Ineffective cough
 How frequently?
 When?
 Noisy breathing (the sound of air bubbling through secretions, or a dry whistling)
 Visible secretions at the tracheostomy tube opening
 Cough with the sound of secretions in the tube
 Rapid breathing or laboured breathing
 Restlessness, crying in a child
 How?
 Mask

16. Suction

17. Cuffed Tracheostomy Tubes
 Why the cuff?
 Bleeding
 Assisted ventilation
 Aspiration
 Disadvantages of cuff
 Pressure on tracheal walls
 Suprastomal sump/collection
 Voice?
 Periodic cuff deflation
 Every 2 hours – for at least 5 minutes
 Avoid deflation in first 6-8 hours after tracheostomy

18. Changing of Tracheostomy Tube
 When?
 Every1-4 weeks
 How?
 Mask
 Patient’s position
 Suction & cuff deflation
 Old tube removal
 Local antiseptic cleaning – followed by drying
 New tube preparation; cuff inflation & deflation
 Tube insertion – from the side; jelly?
 Remove obturator/stilette, secure tube & inflate cuff
 Repeat suction, if required

19. Changing of Tracheostomy Tube

20. Emergencies & their Management
 Immediate/Early Postoperative Complications
 Late

21. Emergencies & their Management
 Tube blockage
 Desaturation
 Noisy breathing
 Stridor
 Laboured breathing / dyspnoea / respiratory distress
 Tube dislodgement / false tract
 Bleeding
 Through the tube? Around the tube?
 Excessive secretions
 Through the tube? Around the tube?
 Subcutaneous emphysema
 Aspiration / dysphagia?

22. Emergencies & their Management
 When in doubt?
 Call me & ask!

23. Decannulation & Stoma Closure
 When?
 Complications
 Difficult decannulation
 Downsizing
 Role of fenestration?
 Roll of cuff?
 Tracheocutaneous fistula

24. Any questions?

25. Thank you.