Care of patient with tracheostomy

Care of patient with tracheostomy

1. Care of patient with tracheostomy PRESENTED BY Brincy Darwin John

2. What is tracheostomy? Tracheostomy is a surgical procedure in which an opening is done into the trachea to prevent or relieve airway obstruction and/or to serve as access for suctioning and for mechanical ventilation and other modes of oxygen delivery (tracheostomy collar, T-piece).

3. What is tracheostomy? A tracheostomy can facilitate weaning from mechanical ventilation by reducing dead space and lowering airway resistance. It also improves client comfort by removing the endotracheal (ET) tube from the mouth or nose.

4. What is tracheostomy? The tracheostomy is preferred over an ET when an artificial airway is needed for more than a few days. Methods can be instituted for the client to eat and speak, as well.

5. INDICATION OF TRACHEOSTOMY To facilitate weaning from positive pressure ventilation in acute respiratory failure or prolonged ventilation. To secure and clear an airway in the upper respiratory tract where obstruction is a risk. To protect/ minimise risk of aspiration in the patient with poor or absent cough reflex. To obtain an airway in patients with injuries or surgery to the head and neck area.

6. Parts of tracheostomy

7. CARE OF PATIENT WITH TRACHEOSTOMY 1. Assessment: Assess for sign of airway obstruction. Like wheeze, crackle, ineffective coughing, restlessness, tachypnea or bradycardia and cyanosis. increased peak inspiratory pressure and decreased tidal volume during pressure ventilation. Check SpO 2 and SaO 2. Analyze the ABG.

8. CARE OF PATIENT WITH TRACHEOSTOMY 2. Suctioning: Turn on suction apparatus and set the vacuum suctioning at 80 to 120 mm of Hg. Secure one end of the connecting tube to suction source and other end in convenient location within reach. Monitor patient’s cardiopulmonary status before, during and after suctioning.

9. CARE OF PATIENT WITH TRACHEOSTOMY 2.A Open Suctioning: Open sterile catheter on clean surface. Inside packet should be sterile. Take a sterile container and fill it with 100ml normal saline or sterile water. Don glove. Pick up the suction catheter, avoid touching to nonsterile surface

10. CARE OF PATIENT WITH TRACHEOSTOMY 2.A Open Suctioning: With non dominant hand take the connecting tube, secure the catheter to connecting tube. Check equipment proper functioning by suctioning the small amount of water from the container. Hyper oxygenate the patient at least for 30 seconds by 3 methods;

11. CARE OF PATIENT WITH TRACHEOSTOMY 2.A Open Suctioning: 1. press the suction hyperoxygenation button on ventilator with non dominant hand. 2. Increase the baseline FiO 2 on ventilator. 3. Bag mask ventilation (5 to 6 breaths over 30 seconds) (One handed bagging rarely achieve adult tidal volume of >500 ml)

12. CARE OF PATIENT WITH TRACHEOSTOMY 2.A Open Suctioning: Remove ventilator circuit, negative pressure should be open to air, quickly insert the catheter until resistant met then pull back 1 to 2 cm before performing suctioning. Place the non dominant hand on control vent and perform suctioning for less than 10 seconds.

13. CARE OF PATIENT WITH TRACHEOSTOMY 2.B Closed Suctioning: Connect the suction tubing to closed suction system, prefilled syringe should attached to the system. Perform other steps same as open suctioning technique.

14. CARE OF PATIENT WITH TRACHEOSTOMY 3. Stoma care Moisten cotton-tipped swabs or a gauze pad with sterile physiologic saline to clean the stoma, the outer cannula, and the faceplate. The peristomal area should be cleaned using a semicircular motion in an inward to outward direction. Pat the skin dry with gauze pads to prevent breakdown.

15. CARE OF PATIENT WITH TRACHEOSTOMY 3. Stoma care Assess the peristomal skin for signs of infection or irritation. Change the tracheostomy ties if they're wet or soiled with the help of a team member. One of you can hold the tube in place while the other changes the trache holder or ties. Assess the skin under the trache ties for any abnormalities.

16. CARE OF PATIENT WITH TRACHEOSTOMY 3. Stoma care When securing tracheostomy tube ties, only one finger should fit between the patient's neck and the tie. If you're using twill tape take a piece twice the diameter of the patient's neck, attach the ties to one flange, take both ends and place around the neck through the other flange, and knot it close to the flange using a square knot..

17. CARE OF PATIENT WITH TRACHEOSTOMY 3. Stoma care Finish care by placing a clean precut dressing under the faceplate. Don't cut gauze to use under the faceplate as the frayed edges can cause irritation. Peristomal care should be performed at least every 8 hours, but change the dressing as needed.

18. CARE OF PATIENT WITH TRACHEOSTOMY 3. Stoma care Document that you provided trache . care and include the appearance of the peristomal skin and whether you changed the trache . ties and inner cannula. Note the type, amount, color, and odor of secretions, as well as the frequency of suctioning.

19. CARE OF PATIENT WITH TRACHEOSTOMY 3. Reassess the patient. 4. Clean the skin around the stoma 5. Oral hygiene 6. Nebulization 7. Chest physiotherapy.

20. THANK YOU