Tracheostomy care

Tracheostomy care by Haider Mohammed

1. University of Babylon
Faculty Of Nursing
Tracheostomy Care
PREPARED BY:
Master Student
Haider mohammed

2. ANATOMY

3. Tracheostomy
It is a surgical opening in the anterior wall of the
trachea just below the larynx. Or is an operative
procedure that creates a surgical airway in the
cervical trachea.A tracheostomy may be performed
as a permanent and emergency procedure.

4. INDICATIONS:-
1- To provide and maintain patent airway.
2- To enable the removal of tracheo-bronchial
secretions.
3- To permit long term positive pressur ventilation.
4- To improve patient comfort.
5- To decrease the work of breathing and increase
volume of air entering the lungs

5. TYPES OF TRACHEOSTOMY
TUBES
Plastic or metal
Cuffed
Fenestrated

6. TYPES OF TRACHEOSTOMY
TUBE
PLASTIC
METAL

7. TYPES OF TRACHEOSTOMY
TUBES
CUFFED
FENESTRATED

8. Tracheostomy Speaking Valve
Tracheostomy Speaking Valve is designed to allow
tracheostomy patients to vocalize without the need for
finger occlusion. The valve provides low resistant one-
way airflow using a thin silicone diaphragm that opens
on inspiration and closes on expiration. An exclusive
feature of this valve is a "cough-release" mechanism,
eliminating valve or tube dislodgment as a result of
coughing or excessive airway pressure.

9. Indications For use as a one-way speaking valve
on a tracheostomy tube
Features
1- Easy to use and maintain
2- Low resistance to inspired airflow
3-Exclusive cough-release feature

10. speaking valve

11. Contraindications.
1- Suspected CSF leak (BOS fracture) or raised inter
cranial pressure.
2- Tracheo/oesophageal fistula.
3- Cancer in upper GI or respiratory tract.
4- Oesophageal or high GI surgery.

12. ANATOMICAL POSITIONING OF
TRACHEOSTOMY TUBE

13. COMPLICATIONS
Immediate
1- Hemorrhage
2- Hypoxia
3- Trauma to recurrent laryngeal nerve
4- Damage to esophagus
5- Pneumothorax
6- Infection
7- Subcutaneous emphysema

14. COMPLICATIONS
Early
1- Tube obstruction or displacement
2- Pooling of secretions leading to aspiration
3- Bleeding from tracheostomy site
4- Infection

15. COMPLICATIONS
Late
1- Airway obstruction with aspiration
2- Damage to larynx (Stenosis(
3- Tracheal stenosis
4- Tracheomalacia
5- Aspiration and pneumonia
6- Fistula formation .eg. Tracheo- cutaneous or
tracheo-oesopheal

16. CARE OF THE PATIENT WITH
TRACHEOSTOMY
Stoma care
1-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.

17. CARE OF THE PATIENT WITH
TRACHEOSTOMY
Tube care
1- 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.
3- For cuffed tracheostomy tubes the pressure should
be measured in every shift{ as per hospital policy.
{

18. 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.

19. Hazards Of Suctioning
1- Patient anxiety.
2- Changes in ICP.
3- Trauma.
4- Infection.
5- Pneumothorax.
6- Hypoxia.
7- Cardiac hazard.

20. CARE OF THE PATIENT WITH
TRACHEOSTOMY
Humidification
1- The normal humidification and air filtration system
is bypassed if the tracheostomy is in situate
2- Keep patients well hydrated- otherwise secretion
will become thicker and will lead to infection.

21. Nursing Diagnosis
1- Risk of ineffective air way clearance
related to increase secretion secondary to
tracheostomy.
2- Risk for infection related to excessive
polling of secretion.
3- Impaired verbal communication related
to inability to produce speech secondary to
tracheostomy.

22. Nursing Management
1- The patient and all hospital staff will
demonstrate and apply hand washing technique
through hospitalization.
2- the nurse educate the patient and his family
about transmission of infection after discharge.
3- assess and maintain for adequate humidity of
inspired air every two hours.
4- keep stoma free from any debris or mucous
build up as needed
5- check body vital sings.
6- keep patient with comfortable position.
7- give analgesic medication as order.

23. THINGS TO REMEMBER
 DON’T PANIC
 STERILE TECHNIQUE
 SAFTEY FIRST
 CRITICAL THINKING
 NUTRITION
 COMMUNICATION