Tracheostomy CareDr MTD Lakshan

MBBS MS DOHNS FEB ORL-HNS FRCSEd ORL-HNS

Consultant ENT and Head and Neck Surgeon

Tracheostomy?

Surgical Opening in to the Trachea

Image Credit : http://www.hopkinsmedicine.org/tracheostomy/about/types.html

Indications?

Prolonged Ventilation

Airway ObstructionBroncho-pulmonary

suction

Congenital

Neoplastic

Infection/

Inflammatio

n

Traumatic

Post

Surgical

Airway

Obstruction

Infection

Bleeding

Fistulations

Vascular/

Tracheo-

oesophagea

l

Block /

Displaceme

nt

Surgical

Emphysem

a

Complicatio

ns

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

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

Suctioning

frequency

4-6H

duration

5-10 s

pressure

80-120mmHg

size

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.

Equipment

• Suction machine

• Suction tubes

• Normal saline

• Sterile or clean cup

• Ambu bag

• Gauze swabs

• Gloves \ mask

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

WHAT TO DO IF THE TRACHY

TUBE COMES OUT

ACCIDENTALLY• 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

CPR with Trache

• Open the air way.

• Suck the trachy tube.

• If the trachy has an inner cannula remove it.

• Change the trachy tube.

• Give two gentle puffs of air into trachy tube using

an ambu bag.

Home Tracheostomy

Care• An effort is required for successful transition with a new tracheostomy

to their home.

• Parents / Care givers should educate about,

• Suctioning a tracheostomy.

• Eating with tracheostomy.

• Home equipments and disposal supplies.

• Accidental decannulation

• Financial and support resources

• Arranging follow up care

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

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

• —> How was it done—> complications—> Post

operative monitoring —> suctioning / tube

changes —> emergencies at ward — > home

care —> Decannulation

Surgey

Indications

Post operative care

Complications

Suctioning / tube changes

Emergencies

Home care

Tube removal

Thank You!lakshent@gmail.com

@mtdlakshan

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