Tracheostomy care

1. Tracheostomy
care

2. TRACHEOSTOMY CARE
Definition
A tracheostomy is a surgically created opening in the trachea. A
tracheostomy tube is placed in the incision to secure an airway
and to prevent it from closing.
Tracheostomy care is generally done every eight hours and
involves cleaning around the incision, as well as replacing the
inner cannula of the tracheostomy tube. After the site heals, the
entire tracheostomy tube is replaced once or twice per week,
depending on the physician's order.

3. Horizontal skin incision midpoint between cricoid and
suprasternal notch
Strap muscles exposed
Strap muscles separated in midline to expose thyroid
isthmus à divided & ligated
Trachea exposed
Fenestra created by
Excising anterior tracheal wall between 2nd & 3rd or 3rd &
4th tracheal rings
Vertical incision is used in children
Opening in trachea is ready to take appropriate diameter
tracheostomy tube

4. • Patients being weaned
off trach tubes may
have either a cuffless
or fenestrated tube to
allow airflow past the
larynx
Communication and Tracheostomies

5. Complications:
Operative (CHEAP)
◦ Cricoid injury
◦ Hemorrhage
◦ Surgical Emphysema
◦ Air embolism
◦ Pneumothorax

6. Purpose/ goal
The goals of tracheostomy care are
to maintain the patency of the airway,
prevent breakdown of the skin surrounding the
site, prevent infection.
Sterile technique should be used during the
procedure.

7. Cuffed Tracheostomy Tube
Consists of three
parts:
• Outer cannula
with an
inflatable cuff
and pilot tube
• An inner cannula
• An obturator

8. • More suitable for long term ventilation
• patient must have effective cough and
gag reflex to prevent aspiration risk
Cuffless tubes

9. • Have an opening on the
posterior wall of outer cannula
allowing air to flow through
the upper airway and hence
allows patient to speak
• Often used during weaning
process
Fenestrated Tube

10. • Be aware of when and why the trach
was inserted , how it was performed, the
type and size of tube inserted
• Examine the patient at the start of visit.
Observe for signs of hypoxia, infection
or pain
• Chest: Auscultate breath sounds
• Examine trach tube, as well as stoma
site for redness, purulent drainage, and
bleeding around the stoma
Nursing Care: Examination

11. • Necessary for all trach
patients to remove
secretions
• Routinely done 2x / day,
but more often if a
newly placed
tracheostomy or when
there is infection present
• Suctioning activates
psychological and
physiological reflexes
that make the
experience both
uncomfortable and
frightening
Nursing Care - Suctioning

12. • The majority of trach tubes have inner
cannulas that require cleaning one to
three times daily unless they are
disposable
• Use sterile technique to clean the
reusable cannula with ½ strength
hydrogen peroxide and normal saline
Maintenance of the inner cannula

13. • Cuff pressure (balloon)
should be maintained at 20
mmHg of pressure via a
manometer – should be
assessed daily;
• if you don’t have a
manometer measuring
device – check With a
stethoscope placed on the
neck, inflate the cuff until
you no longer hear hissing;
deflate the cuff in tiny
increments until a slight his
returns….
Nursing Care – Trach cuff pressure

14. • Tube changes can be
done safely on a 1-3
month basis using a clean
technique
• Silicon tubes can crack
and tear; soft PVC tubes
can stiffen with time
Nursing Care: Changing the Trach tube

15. • Clean stoma with
Q-tip moistened
with NS;
• Avoid using
hydrogen peroxide
unless infection
present (as it can
impair healing) –
• Dressings around
the stoma are
changed
Nursing care: Tracheostomy Site Care and Dressing

16. Aftercare
After tracheostomy care is finished,
the soiled dressing and supplies should be discarded, either
in the garbage or in a biohazard container if there is a large
amount of blood.
The patient may need to be suctioned again, and his or her
respiratory status should be reassessed.
Again, pain medication should be offered as appropriate.