Tracheostomy care involves several important steps. A trained nurse should monitor the patient closely after surgery, keeping necessary supplies at hand. The cuff should remain inflated for 12 hours then deflated for 5 minutes each hour. Signs of needing suction include rattling sounds, fast breathing, or mucus in the opening. Tube changes are best done by the surgeon and involve smaller tubes and oxygen. Precautions to prevent objects from entering the trachea are important for safety. Decannulation should be done gradually by closing the tube for longer periods.

1. Tracheostomy Care
Dr Ibrahim Baloch
Resident, Thoracic surgery department
Combined Military Hospital
Rawalpindi, Pakistan

2. Tracheostomy
Tracheostomy is an operative
procedure that creates a
surgical airway in the cervical
trachea.

3. Types
• Emergency
• Elective
• Permanent
• Percutaneous dilational
• Cricothyroidotomy (aka
Mini tracheostomy)
• High, mid or low

6. Technique

8. Tracheostomy Post Op
• A trained nurse should be in attendance
• Patient should be close to nurses station
• Writing materiel and a bell should be with the
patient
• Tube should be stitched to skin
• Tapes should be tied with a reef knot on both sides
of neck when the head in the neutral position

9. Tracheostomy Post Op
• Tracheostomy tray should be with the patient
• Keep the cuff inflated for 12 hours while deflating
the cuff for 5 min every hour
• Then deflate the cuff if no risk of aspiration or if
not ventilating
• Humidification of air
• Breathing exercises

15. Indications
• Rattling mucus sounds from the trachea.
• Fast breathing.
• Bubbles of mucus in trachea opening.
• Older children may signal a need to be suctioned.
• Signs of respiratory distress.
• Dry raspy breathing.

18. Equipment
• Suction machine
• Suction tubes
• Normal saline
• Sterile or clean cup
• Ambu bag
• Gauze swabs
• Gloves mask

25. Tube Change
• Better to be done by the surgeon who did the
surgery
• Smaller size tracheostomy tubes, tracheal dilator,
oxygen, suction
• How to rail - road in difficult intubation

26. WHAT TO DO IF THE TRACHY TUBE COMES OUT
ACCIENTALLY
• Try to stay calm.
• Reinsert tube immediately.
• Use smaller size if the regular size does not fit.
• Opening the air way is the first priority ( use tracheal dialator)
• If you cannot reinsert the tube observe the child.
• Apply oxygen.
• Inform doctor.
• Monitor oxygen saturation

27. Precautions
• Try to treat child / patient as normally.
• Use shallow water for bath.
• No swimming.
• Avoid powder, chlorine bleach.
• Prevent foreign objects entering the trachy
tube.
• Avoid chalk dust.
• No plastic bibs.
• No necklaces.
• Avoid animals with fine hair.
• Do not allow anyone to smoke near child.
• There must be a trained person with the
patient at all time

28. Decannulation
• Should be done in a step wise fashion
• Uncuffed fenestrated small size tube should be inserted
• Close the tube during day time
• Tube close during day and night time (24Hrs)
• If patient tolerate can decannulate