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1. Howler Medical University
College of Nursing /Nursing Department
Adult Nursing Specialty
Ph.D. educational program
TP training course
2021-2022
Tracheostomy care and Chest Physiotherapy
Student name
Yousif Bakr Omar
M.Sc. in Nursing
Supervised name
Assistance Professor Dr. Abdulla Faqe Yazdin
2021
2. History of critical care nursing
The Crimean War, in the 1850s, nurses created a
separate area near the nursing station for critically
injured British soldiers; some identify this as the
beginning of intensive care.
3. Modern critical care began with the development of
new technology, specifically the iron lung and
negative pressure ventilation used during the 1952
polio epidemic. Mechanical ventilators first became
commercially available in the 1960s, followed by
increasing use of automated monitoring of vital
signs with alarms.
4. • Within less than fifteen years, 90 percent of U.S.
hospitals with five hundred or more beds had
opened intensive care units (ICUs). The rapidly
increasing number of critical-care nurses soon
collectively organized a national group, the
American Association of Critical-Care Nurses
(AACN), which developed standards of care, a
core curriculum to educate new nurses entering
the field, and a national examination to certify
nurses’ knowledge and competency in critical
care.
5. Critical care nursing
• The American Association of Critical Care Nurses
(AACN) defines critical care nursing as “a specialty
within nursing that deals specifically with human
responses to life-threatening problems”.
• Critical care units range from open-heart recovery
units, burn units, and neurologic intensive care
units (ICUs) to surgical ICUs, medical ICUs, and
cardiac care units. All have distinct qualities while
sharing several similar attributes.
6. What is the respiratory system?
• The respiratory system is the network of organs
and tissues that help breathe. It includes airways,
lungs and blood vessels. The muscles that power
lungs are also part of the respiratory system.
These parts work together to move oxygen
throughout the body and clean out waste gases
like carbon dioxide.
7. • What does the respiratory system do?
• The respiratory system has many functions. Besides
helping inhale (breathe in) and exhale (breathe out),
it:
1. Allows to talk and to smell.
2. Warms air to match body temperature and
moisturizes it to the humidity level body needs.
3. Delivers oxygen to the cells in the body.
4. Removes waste gases, including carbon dioxide,
from the body when exhale.
5. Protects the airways from harmful substances and
irritants.
9. Some of the bones and muscles in the respiratory
system include:
1. Diaphragm:
2. Ribs:
Other components that work with the lungs and
blood vessels include:
a) Alveoli:
b) Bronchioles:
c) Capillaries:
d) Lung lobes:
e) Pleura:
10. Some of the other components of the respiratory
system include:
1. Cilia:
2. Epiglottis:
3. Larynx (voice box):
11. • Tracheotomy is the surgical incision into the
trachea to create an airway.
• A tracheotomy can be an emergency procedure or
a scheduled surgery. Tracheostomies can be
temporary or permanent.
• Cuffed endotracheal tubes (ETTs) in a variety of
sizes and may be plastic, silicone, or metal, and
cuffed, uncuffed, or fenestrated: 6.0, 7.0, 8.0, and
9.0 mm, sizes 6 to 9 mm for most adults. A
tracheostomy is a 51- to 76-mm (2 to 3-inch) tube
and may have one or two lumens
12. • Single-lumen tubes consist of the tube; a built-in
cuff, which is connected to a pilot balloon for
inflation purposes; and an obturator, which is
used during tube insertion. The double-lumen
tubes consist of the tube with the attached cuff,
the obturator, and an inner cannula that can be
removed for cleaning and then reinserted or, if
disposable, replaced by a new sterile inner
cannula.
13.
14. • Single lumen (no inner cannula) tracheostomy tubes
should be changed every 7–10 days.
15. • For patients receiving mechanical ventilation, a
cuffed tube is used. A noncuffed tube is used
when mechanical ventilation is not required.
16. • Check the cuff pressure at least once during
each shift, especially with the minimal leak
technique, and keep the pressure at 14 to 20
mm Hg.
• Most cuffs are adequately inflated with less
than 10 mL of air.
17. • To prevent the complications associated with cuff
design, only low-pressure, high volume cuffed
tubes are used in clinical practice.
18. • Has three parts: Outer cannula (with or without
an inflatable cuff); obturator that fills the blunt
end of the outer cannula to promote ease of
insertion into the tracheotomy; and inner cannula
(disposable or can be cleaned).
20. The tracheostomy tube is secured in place with
sutures and tracheostomy ties or Velcro tube
holders.
• Tracheostomy ties should not be changed for
first 72 hours after the tracheotomy procedure
Secure tracheostomy by:
• a. Tracheostomy tie method
• b. Tracheostomy tube holder method
21. • The tracheostomy collar is used to deliver high
humidity and the desired oxygen to the patient
with a tracheostomy. A special adaptor, called the
T-piece, is used to deliver any desired Fio2 to the
patient with a tracheostomy, laryngectomy, or
endotracheal tube.
22.
23.
24. • Patients with new tracheostomy frequently
have bloody secretions for 2 to 3 days after
procedure and for 24 hours after each
tracheostomy tube change.
• After the tube is removed, stomal closure
generally occurs over a 4- to 7-day period with
no additional intervention
25. Indications for Endotracheal or Tracheostomy Tube
Insertion
1. Acute respiratory failure, central nervous system
(CNS) depression, neuromuscular disease,
pulmonary disease, chest wall injury.
2. Upper airway obstruction (tumor, inflammation,
foreign body, laryngeal spasm).
3. Anticipated upper airway obstruction from edema
or soft tissue swelling because of head and neck
trauma, some postoperative head and neck
procedures involving the airway, facial or airway
burns, decreased LOC.
26. 4. Need for airway protection (vomiting, bleeding, or
altered mental status).
5. Aspiration prophylaxis.
6. Fracture of cervical vertebrae with spinal cord
injury; requiring ventilatory assistance.
27. Complication
Complications during and immediately after
endotracheal intubation and tracheostomy include:
cardiovascular compromise, bleeding, injury to the
tracheal wall, damage to the vocal cords,
pneumothorax, pneumomediastinum and
subcutaneous emphysema.
Late complications of tracheostomy include
tracheal stenosis, tracheomalacia and tracheo-
oesophageal fistula and infection.
28. Nursing intervention
• Include providing humidification, managing the
cuff, suctioning, establishing a method of
communication, and providing oral hygiene.
