Tracheostomy care

1. TRACHEOSTOMY
CARE

2. INTRODUCTION
Tracheostomy is the formation of an opening into the trachea usuall
second
and third rings of cartilage.

3. INDICATIONS
• Facilitate weaning from mechanical ventilation by decreasing anat
space.
• Prevention / treatment of retained tracheo-bronchial secretions &
airway obstruction
• Bypass acute upper airway obstruction

5. TYPES OF TRACHEOSTOMY
• A temporary tracheostomy can be formed when patients require lo
respiratory support or are unable to protect their own airway.
• A tracheostomy tube will be inserted to maintain the patency of th
• This can be removed when the patient recovers.Atemporary trache
become long term if the patient’s condition requires this.

6. TYPES OF TRACHEOSTOMY
• 2. A permanent tracheostomy is created where the trachea is brou
surface of the skin and sutured to the neck wall. Stoma is kept ope
rigidity of the tracheal cartilage.The patient will breathe through th
the rest of his/her
life.

7. RISKS
• Tube dislodgement leading to loss of airway.
• Haemorrhage
• Infection
• Communication problem

8. PRECAUTIONS WHILE HANDLING TRACHE
• Ensure tapes are secure and not too tight.
• Two lengths of tape must be used when securing the tube. Use do
without bows or any padding.
• Tapes that are well secured should allow two fingers to pass freely
inside of the tapes.
• Have spare tracheostomy tubes (one the same size and one a size
tracheal dilators next to patient’s bed.

9. PRECAUTIONS WHILE HANDLING TRACHE
• Check that airway remains patent.
• Blockage may be due to an increase of secretions or the tube slipp
trachea.
• When suctioning ensure to support the tube while withdrawing su

10. PRECAUTIONS WHILE HANDLING TRACHE
• Inner tube is removed and cleaned as required.
• Insert temporary inner cannula during cleaning of the permanent
• Inner cannulas are cleaned under running water and then replaced
• For cuffed tracheostomy tubes measure cuff pressure.
• The tracheostomy site should be assessed at least each shift and d
be done.

11. PRECAUTIONS WHILE HANDLING TRACHE
• Never use cotton. Always use gauze for tracheostomy dressings.
• Humidification must be maintained at all times.
• The dressing around the tracheostomy should be changed at least
This helps to prevent infection at the stoma site and within the res
(lungs). Changing it also helps to promote the skin's integrity

12. PRECAUTIONS WHILE HANDLING TRACHE
• A new dressing helps to insulate the skin and absorb the secretion
leak around the stoma.
• A wet dressing should be changed immediately. This breeds bacte
to health complications.

13. PRECAUTIONS WHILE HANDLING TRACHE
• Change the ribbons (ties) that keep the tracheal tube in place if th
wet. Make sure that tracheal tube is in place while changing the rib
• Always use (PPE) barrier precaution before direct contact to the pa
• Cuff pressure should be less than 25mmhg to prevent injury and m
15mmhg to prevent aspiration and monitor cuff pressure in every

14. TRACHEOSTOMY DRESSING
• The dressing should be changed at least once daily and more freq
becomes wet with secretions.
• Arrange emergency equipment.
• Ensure all the equipment required for the procedure is present.
• Explain the procedure to the patient.
• First nurse – holds tracheostomy tube stable and oxygen in place (
with the patients neck slightly extended.

15. TRACHEOSTOMY DRESSING
• Second nurse - remove tapes and old dressing.
• Second nurse – clean stoma site with gauze soaked in antimicrobia
sterile saline if necessary and dries with gauze.
• Observe for signs of infection, bleeding, etc.
• Apply clean key hole dressing– split sitting at the top.
• Apply clean securing tapes. The tapes should only be loose enoug
fingers inside.

16. TRACHEOSTOMY DRESSING
• Dispose of all dirty dressings.
• Document the dressing change in the nurse’s notes– any other find
signs of infection should be reported to the senior nurse/doctor a
documented in the notes.

17. SUCTIONING
• Suctioning clears secretions from the airway of patients who canno
expectorate them without assistance. It involves aspirating secretio
catheter connected to a suction source.

18. PURPOSES
• Maintain a patent airway.
• To improve oxygenation and reduce the work of breathing.
• To remove accumulated trachea-bronchial secretions using sterile
• Stimulate the cough reflex.
• Prevent pulmonary aspiration of blood and gastric fluids.
• Prevent infection and atelectasis.

19. PROCEDURE
• Assess patient’s need for suctioning
• Wash hands
• Wear sterile gloves and mask
• Second nurse is required to assist to maintain sterile procedure
• Turn on suction apparatus and set vacuum regulator to appropriat
pressure.
• Recommended pressure : In adults: 100-120 mmHg, Children: 80 –
Infants: 50 – 80 mmHg

20. PROCEDURE
• Open sterile package (catheter size not exceeding one-half the inn
the airway) on a clean surface, using the inside of the wrapping as
• Pick up suction catheter, being careful to avoid touching non steril
With non dominant hand, pick up connecting tubing. Secure suctio
connecting tubing. Maintains catheter sterility.

21. PROCEDURE
• Check equipment for proper functioning by suctioning a small am
saline from the container.
• Hyper-oxygenate and hyperventilate via 3 breaths by giving patien
manual breaths on the ventilator before suctioning. Hyperoxygena
O2 is used to offset hypoxemia during interrupted oxygenation an

22. • Pre-oxygenation offsets volume and O2 loss with suctioning. Patie
PEEP should be suctioned through an adapter on the closed suctio
• Opens artificial airway for catheter entrance. Have second nurse as
indicated to avoid unintentional extubation.

23. PROCEDURE
Replace O2 delivery device or reconnect patient to the ventilator.Wit
suction, gently but quickly insert catheter with dominant hand dur
until resistance is met; then pull back 1-2 cm above carina.

24. PROCEDURE
• Apply intermittent suction by placing and releasing dominant thum
control vent of the catheter. Rotate the catheter between the domi
and forefinger as you slowly withdraw the catheter.
• Time should not exceed 10-15 seconds. Intermittent suction and c
prevent tracheal mucosa when using regular
suctioning methods.

25. PROCEDURE
• Replace oxygen delivery device. Hyper-oxygenate between passes
following suctioning procedure.
• Rinse catheter and connecting tubing with normal saline until clea
• Removes catheter secretions.
• Monitor patient’s cardiopulmonary status during and between suc
Observe for signs of hypoxemia, e.g. dysrhythmias, cyanosis, anxie
bronchospasms, and changes in mental status.

26. PROCEDURE
• Once the lower airway has been adequately cleared of secretions,
airway suctioning. Removes upper airway secretions.
• The catheter is contaminated after nasal and oral pharyngeal sucti
should not be reinserted into the endotracheal or tracheostomy tu

27. PROCEDURE
• After completion of upper airway suctioning, discard suction cathe
hands.
• Turn off suction device. Reposition the patient.
• Reassess patient’s respiratory status. Monitor oxygen saturation th
procedure.

28. Thank you