This document provides information about tracheostomies including: - A tracheostomy is a surgical opening in the front of the trachea to facilitate ventilation. - It has been performed since 100 BC and the first successful one was in the 15th century. - Tracheostomies can be temporary or permanent and use different types of tubes. - Indications include mechanical airway obstructions, infections, trauma, burns and impaired breathing. - Nursing care involves cleaning tubes, changing inner and outer tubes, caring for the stoma site, suctioning secretions, providing humidification and monitoring for complications. - The goal is to maintain an open airway and prevent infections while the patient he

1. PREPARED BY
DR.SHALI B.S
PROFESSOR
MAMATA COLLEGE OF NURSING.KHAMMAM

3. WHAT IS A TRACHEOSTOMY?
“ A surgical opening in the anterior wall of the
trachea to facilitate ventilation”

4. History
 Tracheostomy is one of the oldest surgical
procedures.
 Asclepiads of Persia is credited as the first person to
perform a tracheotomy in 100 BC.
 The first successful tracheostomy was performed by
Brasovala in the 15th century.

5. Anatomy
 Trachea lies in midline
of the neck extending
from cricoid cartilage (C6) superiorly to the
tracheal bifurcation at the level of sternal angle
(T5).
• Comprises 16-20 C shaped cartilage rings.
• Length 10-12cm.
• Diameter 15-20mm.

6. TYPES OF TRACHEOSTOMY
• Temporary
 Permanent

7. Types of Tubes
 Cuffed tubes
 Un-cuffed
 Fenestrated
 Inner cannula
Silver, Silicone and Rubber
 Mini Tracheostomies

8. Cuffed Tubes
 Allows ventilation and
prevents aspiration

9. Un-cuffed Tubes
 Maintains airway
 Increase airflow to the larynx

10. Fenestrated Tube
 Increases airflow to larynx

11. Inner Cannula
Allows maintenance of tube
patency
-Aids tube hygiene
-Close observation

12. Silver Negus
Metal Tracheostomy Tubes
 These are made of silver because the metal is inert
and does not irritate the tissues.

13. Metal Tracheostomy Tubes

14. Mini Tracheostomy
 Minitracheostomy (cricothyroidotomy) is for the
treatment or prevention of sputum retention after
thoracotomy or laparotomy . It is an alternative to
naso-laryngeal suction or regular flexible
bronchoscopy.

15. PARTS
 The outer tube is remines held in place by a ribbon or
tie which is passed through the loop on the either side
of the opening of the tube.
 The obturator is used only to guide the outer tube
during insertion and is removed immediately after the
outer tube is placed .
 The inner cannula is fits in side the outer tube and
locked in place after the obturator is removed.

16. INDICATIONS FOR TRACHEOSTOMY
 To actual mechanical obstructions, including:
tumour, stenosis, oedema of the larynx and trachea
 Congenital abnormalities
 Inflammation or infection e.g...diphtheria, laryngitis,
tetanus etc.
 Trauma - accidental and surgical to the larynx and
trachea
 Severe burns around the face and neck
 Foreign bodies
 Impaired respiratory muscle function- paralysis

17. Cont…
 To aid prolonged and assisted ventilation due to:
 Coma
 Neuromuscular disorders
 Chronic obstructive pulmonary disease (COPD)
 Multiple injuries
 To aid aspiration of bronchial secretions.
 Patients undergoing major surgeries to the mouth,
neck
 Situation where endotracheal tube cannot inserted
or contra-indicated
Cont…

18. NURSING CARE OF PATIENT WITH
TRACHEOSTOMY
EQUIPMENT
 A spare tracheostomy tube of the same style and
size
 Tracheal Suction equipment - catheters,
connection tubing, containers, gloves, dilators,
Sterile water
 Humidification equipment and Syringes and
Stoma dressings

19. Tube cleansing:-
 If re-usable, and for the same patient, inner and outer
tubes can be cleansed by soaking the parts in a cleansing
solution, such as a mild detergent, half-strength hydrogen
peroxide, normal saline or a weak solution of sodium
bicarbonate for a maximum of two hours.
 The lumen of silver tubes is cleaned with a soft bottle
brush under running water, but this practice should be
avoided with plastic tubes because brushing could damage
the tube.
 The tube should be stored dry. Silver parts can also be
autoclaved

20. Outer tube changing:-
 The first outer tube change usually takes place after
five to seven days, to allow for the formation of a tract.
 After this period, the frequency of changing depends
on individual needs and may vary from daily to every
few weeks.
 The procedure should always be carried out by two
nurses: one to remove the soiled tube, the other to
immediately insert the clean tube, and tie the tapes.

21. Inner tube changing: -
 The inner tube should be changed at least twice daily.
Once it has been removed, a clean one should be
inserted immediately.

22. Stoma care:-
 The neck incision site must be cleaned twice a day
because tracheal secretions can easily infect it.
 During stoma toilet, the soiled dressing is removed
and the wound, under the tube flanges, is cleansed
using a moistened cotton wool applicator or swab.
 Normal saline is often the chosen cleansing
product and can be followed with the application
of a small amount of mild lubricant, such as white
soft paraffin, if the skin needs further protection

23. Cont..
 Avoid using powders, sprays, or
shaving cream around the tube.
 Avoid allowing water to enter the
opening during bathing
 Gauze squares are used to apply a small amount of
antibiotic ointment to help in wound healing
around the stoma

24. Suction
Indications of suction
 Secretions in the trachea
 Suspected aspiration of gastric or upper airway
secretions
 Increase in peak airway pressures when on ventilator
 Increase in respirations or sustained cough or both
 Gradual or sudden decrease in ABG
 Sudden onset of respiratory distress

25. Suctioning of the trachea is done
as follows:-
 Wash hands
 Put on glove
 Select appropriate suction catheter. They should be smooth.
It is lubricated with normal saline before introduced in to
the trachea.
 Rinse the lumen of the catheter with normal saline
 Gently insert in to trachea-usually 6-8 inches. If deep
suction is indicated
 Do not apply suction during the insertion
 Apply suction when secretions are audible
 Slowly withdraw the catheter while rotating it and apply
suction immediately.
 Suction should not be continued for more than 5-10 seconds
to prevent hypoxia

27. Humidification
 Humidification of the inspired gas is a standard of care
for tracheostomized patients.

28. RECORDING
DATE,TIME;
Descriptions of secretions
-watery (thin)
- Scant- small amounts.
- Copious ( large amounts)
-Frothy (with bubble)
Color - clear, white, yellow,
green, gray, brown, bloddy
Odor

29. COMPLICATION OF
TRACHEOSTOMY
 1. Displaced tubes ,
 2. Blocked tubes
 3. Emphysema
 4. Wound and respiratory tract infections
 5. Haemorrhage
 6. Tracheal stenosis.
 7. Tracheo-oesophageal fistula

30. CONCLUSION
 The most common indications for tracheostomy is
mechanical ventilation with prolonged tracheal
intubation.
 Tracheostomy: emergency and elective, improve
quality of life.
 Should maintain aseptic precautions
 Appropriate postoperative tracheostomy care to
reduce complications.

31. “SAVE ME WITH YOUR CARING
HANDS “

32. THANK YOU