This document defines and describes tracheostomy, including its purpose, indications, types of tubes, and care considerations. A tracheostomy is a surgical opening made in the trachea to help maintain airway patency or facilitate ventilation. Common indications include upper airway obstruction, need for pulmonary toilet or long-term ventilation. Tracheostomy tubes can be temporary or permanent. Proper care involves suctioning secretions, humidifying air, changing dressings aseptically, and assessing for potential complications like infection or inability to communicate.

1. Management of client with
Tracheostomy Tube
By :
Astuti Mishra

4. Definition:
 A Tracheostomy is an artificial opening /or
surgical opening made into the trachea.
Or
 Making an opening in the anterior wall of the
trachea and its converting this opening in to a
stoma on the surface of skin is called
Tracheostomy. Or
 The Tracheostomy means making an artificial
opening in the trachea to cope with
respiratory insufficiency.

5. Tracheotomy
• operative procedure that creates an
artificial opening in the trachea.
Tracheostomy
• creation of permanent or semi
permanent opening in trachea.

6. Purpose:
 To maintain the airways to facilitate the therapeutic
exchanges of gases
 To facilitate Bronchial toilet; to remove tracheal
bronchial secretion
 To maintain Optimum physical comfort
 To decrease airway resistances
 To provide a method of mechanical ventilation
 To improve respiratory efficiency
 To prevent from aspiration & transmission of
pathogenic micro–organism

7. Indications
1. Upper Airway Obstruction.
2. Pulmonary Ventilation.
3. Pulmonary Toilet.
4. Elective Procedure

8. 1. Upper Airway Obstruction
a. Trauma
b. Foreign body
c. Infections
d. Malignant lesions

9. 2. Pulmonary Ventilation
• Tracheostomy should be
performed in a patient still
requiring ventilation through
an endotracheal tube for
more than a one week.

10. 3. Pulmonary Toilet
• Those who cannot cough and
clear their chest.
• Prevent aspiration by low
pressure high volume cuff
tracheostomy tube.

11. 4. Elective Procedures
• For major head and neck
operations.

12. Indication of Tracheostomy
 Airway obstruction:
 Hemorrhage after thyroid surgery or Upper
airway bleeding
 Need for long term airway management.
 Foreign bodies impacted in the larynx.
 Acute Odema of epiglottis e.g. diphtheria,
facial burns.
 Trauma to the pharynx or larynx.

13. Congenital causes:
 Laryngeal weakness stenosis
 Traumatic cause
 Inflammatory causes, diseases condition
 Decrease level of consciousness
 Inability to clear lower air secretion
 Tracheal laryngeal fracture
 Burnt airway
 Need for continuous mechanical ventilation
 Tumor in respiratory airway

14. Retained secretion in the tracheo-
bronchial tree:
 Unconscious pt following head injury and
poisoning.
 Chest injuries pt unable to cough.
 Paralysis of the muscles of respiration
 Poliomyelitis
 Tetanus
 To reduce dead space air by 30%
 For radical surgery in the neck
e.g.Laryngectomy.

15. Types
 Temporary
 Permanent
Method:
Elective / Emergency
• Tracheostomy instrument tray includes
Tracheostomy tube, tracheal hook,trachal
dialtor,tape,etc.
• Tray must be autoclaved and kept in the
casualty room, post op. ward and OT.

16. Types of Tracheostomy tubes:
 Metal, Plastic, Silver, Stainless steel
 Outer cannula, Inner cannula, Obturator
Place – Made vertically incision in the level of
2nd, 3rd, 4th tracheal ring.

17. Care of Tracheostomy patients
 Pre- operative: Explain about procedure
and take consent.
 Post-operative care:
 Suck the secretion from the tracheobronchial
tree by using 50 ml syringe and fine no 8
catheter. It should be done every ½
hrly.Suction apparatus could be used.
 Humidify the air by boiling water in a kettle in
front of the pt.

18. Cont….
 Clean the inner tube as frequently as
necessary.
 Clean the tube frequently as necessary.
 Prophylactic antibiotic should be
administered.

19. Potential problems:
Risk of ineffective airway clearance
 Assess for evidence respiratory distress
tachypnea rate pattern
 Auscultate chest every 2 hourly
 Assess mental status confusion, lethargy
restlessness/ABG analysis
 Assess/observe amount colour, consistency
of secretion.

20. Intervention
 Positioning – semi- fowler’s
 Keep suction equipment & ambu lag at
bedside
 Provide warm humidified air
 Administer O2 as needed
 Encourage patient to cough out secretion

21. Tracheostomies pt with wearing a
thermovent (type of humidifier)

22. Cont…..
 Institute suctioning airway as needed to clear
secretion (instill 2-5 cc normal saline
 Administer stoma care (aseptic technique)
keep stoma clean and dry by using sterile
gauze dressing around tracheostomy side
 Hydration

23. Suction Technique:

25. Risk of aspiration
 Assess swallowing reflexes, gag reflexes
 Maintain fluid food – I/V, (24 hrs) NG tubes,
parental feeding – test “swallow’
 Before feeding inflate the cuff of tube leave it
at lest 1 hrs after the feeding

26. High risk for infection
 Assess and observe – stoma erythema, odor
irritation inflammation pus
 Assess vital sign
 Assess laboratory value WBC/fever, chill,
blood culture.

27. Intervention
 Provide routine Tracheostomy care, careful
hand washing, appropriate use of gloves, use
of supplies, solution; maintain aseptic
technique topical antibiotic, antibacterial
ointment
 Do not allow secretion to pool around stoma

28. Impaired verbal communication
 Assess patient ability to understand the
spoken word
 Assess patents ability to expression

29. Intervention
 Provide call light
 Paper pencil
 Keep patient near the nursing station
 Consult speech therapist

30. Risk for constipation
 Stool softeners, laxatives, enema,
suppository
Fear and anxiety
 Support, reassurance
 Counseling, frequent observation

31. Complications
 Tracheoesophageal fistula – tracheal wall necrosis
 Tracheal dilation
 Tracheal stenosis (at least 1 to 2 yrs)
 Airway obstruction – due to excessive secretion
 Infection bronchial pulmonary infection
 Accidental decannulations
 Subcutaneous emphysema,pneumothorax.
 Injury to ant. jugular vein leading to hemorrhage.