TRACHEOSTOMY CARE

PREPARED BY:

BITTO BABY

BSN,RN

ANATOMY

Tracheostomy

It is a surgical opening in the anterior wall of the trachea just below the larynx.

INDICATIONS:-

To provide and maintain patent airway.

To enable the removal of tracheo-bronchial secretions.

To permit long term positive pressure ventilation.

To improve patient comfort.

To decrease the work of breathing and increase volume of air entering the lungs

TYPES OF TRACHEOSTOMY TUBES

Plastic or metal

Cuffed or uncuffed

Fenestrated or unfenestrated

Double canula or single canula

TYPES OF TRACHEOSTOMY TUBE

PLASTIC

METAL

TYPES OF TRACHEOSTOMY TUBES

CUFFED

UNCUFFED

TYPES OF TRACHEOSTOMY TUBE

FENESTRATED

UNFENESTRATED

TYPES OF TRACHEOSTOMY TUBES

SINGLE CANULA

DOUBLE CANULA

SHILEY CUFFLESS FENESTRATED TRACHEOSTOMY TUBE

ANATOMICAL POSITIONING OF TRACHEOSTOMY TUBE

COMPLICATIONS

Immediate1. Hemorrhage2. Hypoxia3. Trauma to recurrent laryngeal nerve4. Damage to esophagus5. Pneumothorax6. Infection7. Subcutaneous emphysema

COMPLICATIONS

Early

1. Tube obstruction or displacement

2. Pooling of secretions leading to aspiration and LRTI

3. Aspiration

4. Bleeding from tracheostomy site

5. Infection

COMPLICATIONS

Late1. Airway obstruction with aspiration2. Damage to larynx. Eg. Stenosis3. Tracheal stenosis4. Tracheomalacia5. Aspiration and pneumonia6. Fistula formation .eg. Tracheo-

cutaneous or tracheo-oesopheal

CARE OF THE PATIENT WITHTRACHEOSTOMY

Stoma care

1. Meticulous care towards hygiene and asepsis is necessary.

2. Remember the skin surrounding the stoma is also prone to irritation.

3. as per hospital policy}and barrier cream applied to the local skin{ cotton wool should be avoided}

CARE OF THE PATIENT WITH TRACHEOSTOMY

Tube care1. Tubes need to be cleaned.2. The area should be cleaned with normal

saline {In double cannula the inner cannula will need to be removed and to be cleaned. {Usually just with warm water and then left to air dry}

3. For cuffed tracheostomy tubes the pressure should be measured in every shift{ as per hospital policy}and maintained between 15-30cm of water.

CARE OF THE PATIENT WITH TRACHEOSTOMY

Suctioning

1. Suctioning should be done PRN ,after chest PT and Nebulization

2. Use the lowest pressure needed ,usually less than 120 mmHg and definitely not beyond 200mmHg.

3. Suctioning should be performed less than 10seconds.

CARE OF THE PATIENT WITH TRACHEOSTOMY

Humidification

1. The normal humidification and air filtration system is bypassed if the tracheostomy is in situ

2. Keep patients well hydrated- otherwise secretion will become thicker and will lead to infection.

THINGS TO REMEMBER

WHEN IN DOUBT CHANGE IT OUT

DON’T PANIC

STERILE TECHNIQUE

SAFTEY FIRST

CRITICAL THINKING

NUTRITION

COMMUNICATION

CARE….IT INSPIRES AND GENTLY REASSURES !!!!