Tracheostomy is a surgical procedure that creates an opening in the trachea to allow direct access to the breathing tube. It bypasses the upper airway and allows for immediate inspiration, expiration, and removal of secretions. Reasons for a tracheostomy include lung issues, airway compromise from infections or injuries, and burns to the face. Benefits are the ability to eat and talk more easily with less damage to the airways compared to an endotracheal tube. Safety tips include using the correct cannula type for ventilation and only inflating the cuff when on a ventilator. General nursing management involves always having replacement tubes and an obturator available in case of an emergency dislodgement

1. Tracheostomy Basics for NCLEX
ReMar Review
Tracheotomy-- is the INCISION into the trachea
Tracheostomy- is the temporary or permanent opening
This procedure is done under general anesthesia. The benefits are the tube inserted
into the trachea bypasses the nose/mouth and allows immediate:
 Inspiration
 Expiration
 Removal of secretions
Many Reasons for a tracheostomy
Lung issues (cancer, dead space, heavy secretions)
Airway compromised (foreign objects, laryngeal spasms, stenosis)
Infections
Croup
Burns to face
Benefits of the tracheostomy
Patient can eat solids
Patient can talk (if trach cuff is DEFLATED)
Less damage to the airways
No tube in the mouth
Trach tube is more secure
Tracheostomy Basics for NCLEX

2. ReMar Review

3. Tracheostomy Basics for NCLEX
ReMar Review
Safety tips about the parts of a trach:
Fenestrated inner cannulas can NOT be used with mechanical ventilation. If a patient require
ventilation then a non-fenestrated inner cannula must be used!
If the cuff is INFLATED the patient will not be able to breathe through the mouth or nose. It
should only be inflated if mechanical ventilation is in place
The decannulation plug blocks air passing through the trach to allow the patient to breathe
normally through the mouth and nose. It is used for weaning. If the patient experiences
respiratory distress while the plug is on. TAKE IT OFF!
General Nursing Management
Always keep an obturator at the bedside (ex. taped to the wall) for emergencies
Keep a replacement tube at the bedside
Physician does the first tube/dressing change
If a tube is dislodged the nurse should IMMEDIATLEY insert the obturator into
the replacement tube, apply a water soluble lubricant, and the tube is inserted at a
45 degree angle into the neck. Once insertion is complete REMOVE the obturator.
If tube insertion is unsuccessful manually ventilate the patient with an ambu bag
until help arrives. Place patient in semi-fowlers position as well.

4. Tracheostomy Basics for NCLEX
ReMar Review
TRACHEOSTOMY SUCTIONING
1. Assess client for need for suctioning.
2. Wash hands.
3. Gather equipment: suction kit (includes catheter, basin, gloves), suction
apparatus, eye protection and sterile saline.
4. Explain procedure to client. Apply eye protection. Test suction apparatus.
5. Open suction kit. Don gloves.
6. Pour saline into container.
7. Attach catheter to suction tubing.
8. Wrap catheter in hand to maintain its sterility while you turn on suction
equipment.
9. Lubricate tip of the catheter with saline.
10.Have assistant instill 5 cc sterile normal saline into trach on inspiration.
11.Have assistant hyperoxygenate lungs with 100% oxygen via self inflating
breathing (Ambu) bag (2-3 times as client inhales) prior to suctioning
(suctioning reduces oxygen saturation).
12.Without applying suction, insert suction catheter about 6 inches or until
client coughs.
13.Upon stimulation of cough reflex, apply suction intermittently and slowly
rotate the catheter between dominant thumb and forefinger as the
catheter is withdrawn (within 10 seconds).
14.Assess apical pulse and breath sounds.
15.Repeat steps 12 and 13 based on assessment; limit suctioning to 3 passes of
catheter.
16.Assistant should hyperoxygenate client as per Step 3 between each
suctioning pass.
17.Discard equipment, wash hands and document procedure.

5. NCLEX TROUBLE SHOOTING: