The document discusses guidelines for caring for patients in the postoperative period following tracheostomy. The goals of postoperative care are to enable faster recovery, reduce mortality and hospital stay, and provide quality care. Complications can range from 5-40% and include bleeding, infection, and tracheal stenosis. Care involves constant supervision, regular suctioning and cleaning of the tracheostomy tube, humidification, dressing changes, and assessing for complications.

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2. • The post operative period begins from the time the patient
leaves the operating room and ends with the follow up visit by
the surgeon.
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3. Purposes
• To enable a successful and faster recovery of the patient
post operatively.
• To reduce post operative mortality rate.
• To reduce the length of hospital stay of the patient.
• To provide quality care service.
• To reduce hospital and patient cost during post operative
period.
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4. Complications
• Complications 5-40%
• Mortality <2%
• Complications are more frequent in emergency situations,
severely ill patients and young ones.
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5. 1.Constant Supervision
• For bleeding, displacement, blocking of tubes, removing
secretions
• Pt given 100 % oxygen. Deflate the tube cuff.
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6. 2.Suction
• Suction catheter with negative suction pressure (10 -15
mmHg) used.
• Catheter diameter should be < 1/3rd of internal diameter of
tracheostomy tube
• Catheter length introduced just enough to go beyond inner
tube (10 cm)
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7. 3.Tracheostomy tube care
• Inner tube is removed & cleaned when blocked
• Outer tube never removed before 72 hrs to allow formation of
tracheo-cutaneous tract
• Cuff of Portex tube deflated for 10 minutes every 2 hours to
prevent pressure necrosis & dilatation of trachea
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8. 4. Others
• Chest auscultated for confirmation of adequate suctioning. Re-
inflate cuff to a pressure of 25 mmHg. Patient oxygenated
again.
• Tracheostomy wound dressing done BID
• Steam inhalation TID. Moist gauze piece placed over
tracheostomy tube opening. Regular chest physiotherapy,
expectorants & mucolytics given.
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9. 5.Prevention of crusting and tracheitis
• Proper humidification using humidifier or keeping boiling
kettle in room.
• Using a few drops of ringer lactate or normal saline or
hypotonic saline
• Every 2-3 hrs
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10. Complications of tracheostomy
i. Immediate Complications (During tracheostomy)
ii. Intermediate Complications (Few hours or days later)
iii. Late Complications (Due to prolonged use of tube for
weeks-months)
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11. Immediate complications
• Haemorrhage
• Aspiration of blood
• Injury to recurrent laryngeal nerve
• Injury to apical pleura (Pneumothorax)
• Injury to oesophagus (May cause tracheoesophageal fistula)
• Apnoea (Due to Carbondioxide wash out)
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12. Intermediate Complications
• Haemorrhage
• Displacement of tube (Due to use of improper size tube)
• Blocking of tube (Due to excessive crusting/poor
humidification)
• Subcutaneous emphysema
• Tracheitis/Tracheobronchitis with crusting in trachea
• Pulmonary infections (Due to compromised airway defense
mechanism)
• Wound infection & granulation
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13. Late Complications
• Haemorrhage (Due to erosion of major vessels esp
innominate/bracheocephalic art)
• Laryngeal stenosis (Due to perichondritis of cricoid cartilage)
• Tracheal stenosis (Due to tracheal ulceration & infection)
• Tracheoesophageal fistula (Due to erosion of trachea by tip of
the tube)
• Persistent tracheocutaneous fistula
• Difficult decannulation
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14. Indications for changing
Elective:
• Facilitate weaning/speech production
• To increase patient comfort
• To allow non-routine cleaning and dressing of a tracheostomy
wound
• To allow treatment of granulation tissue at stoma site and/or
fenestration
Emergency:
• Blocked tube
• Misplaced or displaced tube
• Cuff failure Faulty tube
• Resuscitation
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15. Care
• A healthy stoma should be clean and dry with pink edges,
though in the early postoperative period it is normal to see
dried blood around the stoma.
• Any redness, swelling, or pus is abnormal.
• A small amount of blood should be expected with each
tracheostomy tube change especially when a cuffed tube is
inserted or removed.
• The constant exposure of the stoma to secretions can be very
irritating to the skin so the stoma must be cleansed regularly
and kept dry.
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16. Key pointsof dressingchangeare:
• Remove old dressing and tapes.
• Clean the stoma and surrounding area with saline and gauze.
• Dry the peri-stoma area.
• Apply keyhole dressing around the stoma/under flange of
tracheostomy tube.
• Apply transparent film dressing if required.
• Inspect dressing frequently.
• Change dressing when exudate visible
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18. Frequency of suctioning
• It is commonly held that suctioning should be done only as
needed,
• In order to prevent obstruction of the tube and the
accumulation of secretions.
• In the early postoperative period the patient will require
frequent suction to clear secretions.
• This need will gradually settle as the trachea becomes
accustomed to the presence of the tracheostomy tube and the
patient learns to clear the secretions by coughing
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19. Humidification
• Mucous membranes often require added moisture because
the tracheostomy tube bypasses the upper airway.
• Humidification can be provided by a tracheostomy collar, or
atomized saline.
• Lack of adequate humidification can cause the trachea to
develop squamous metaplasia, desiccation of the tracheal
mucosa, and impaired ciliary function.
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20. The properties of an ideal humidifier
• Provision of adequate levels of humidification
• Maintenance of body temperature
• Safety
• Lack of microbiological risk to the patient
• Suitable physical properties
• Convenience
• Economy
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21. Conclusions
• The most common indications for tracheostomy is mechanical
ventilation with prolonged tracheal intubation.
• Tracheostomy: emergency and elective, improve quality of life.
• Meticulous surgical technique.
• Appropriate postoperative tracheostomy care to reduce
complications.
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