NURSINGCARE OF PATIENT WITH TRACHEOSTOMY

1. TRACHEOSTOMY CARE
PREPARED BY:
SHIVA NAGU

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 tracheo-
bronchial 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
Immediate
1. Hemorrhage
2. Hypoxia
3. Trauma to recurrent laryngeal nerve
4. Damage to esophagus
5. Pneumothorax
6. Infection
7. Subcutaneous emphysema

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

14. 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

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 hydrated-
otherwise 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 !!!!