Tracheostomy care

Tracheostomy care

1. Tracheostomy care

2. TRACHEOSTOMY CARE Definition A tracheostomy is a surgically created opening in the trachea . A tracheostomy tube is placed in the incision to secure an airway and to prevent it from closing. Tracheostomy care is generally done every eight hours and involves cleaning around the incision, as well as replacing the inner cannula of the tracheostomy tube. After the site heals, the entire tracheostomy tube is replaced once or twice per week, depending on the physician's order.

3. Procedure of tracheostomy Horizontal skin incision midpoint between cricoid and suprasternal notch Strap muscles exposed Strap muscles separated in midline to expose thyroid isthmus à divided & ligated Trachea exposed Fenestra created by Excising anterior tracheal wall between 2 nd  & 3 rd  or 3 rd  & 4 th  tracheal rings Vertical incision is used in children Opening in trachea is ready to take appropriate diameter tracheostomy tube

4. P a t i e n ts be i n g w eaned o f f t r ach t u be s m a y h a v e e i th e r a cu f f l ess o r f ene s t r a t ed t ub e t o all o w a ir f l o w pa s t the lary n x Comm u n i c a t i o n and T r acheo s t om ies

5. Complications: Operative (CHEAP) C ricoid injury H emorrhage Surgical  E mphysema A ir embolism P neumothorax

6. Purpose/ goal The goals of tracheostomy care are to maintain the patency of the airway, prevent breakdown of the skin surrounding the site, prevent infection . Sterile technique should be used during the procedure.

7. Cuf f e d T r acheo s t o m y T ube Con si s ts of th r ee parts: Ou t er c ann u la w i th an i n f l a t abl e c u f f and p i l o t tube An i nne r c annu l a An o btu r a t or

8. Mo r e su i t able f o r l on g t erm v e n t i l a t i on p a t i e n t mu s t h a v e e f f ect i v e c oug h and g ag r e f l e x t o p r e v e n t asp i r a t i o n ri s k Cu f f less tubes

9. H a v e an op e n i n g o n the po s t e r i o r w all o f ou t er c annu l a al lo wi n g ai r t o f l o w th r ough the u pp er air w a y and h e nce al l o w s p a ti e n t t o speak Of t en u se d d ur i n g w ea n i n g p r ocess F ene s t r a t ed T ube

10. Be awar e o f when an d w h y the trach was i nser t ed , how i t was p e r f ormed , the type an d si z e o f tube i nser t ed E x ami n e the p a tie n t a t the st art o f v i s i t. O b se r v e f o r s ig n s o f h yp o xia , i n f ection o r pain Che s t: Auscu l t at e b r e a th soun d s E x ami n e t r a c h tu b e, as w el l a s s t oma s i t e f o r r ednes s , purule n t d r aina g e , and ble e ding a r oun d the s t oma Nu r s i n g C a r e: E x ami n a ti on

11. Ne c essary f o r all t r ach p a ti e n ts t o r emo v e sec r e ti ons R out i ne ly don e 2 x / d a y , bu t mo r e o f t en if a n e wl y p l aced t r acheo s t o m y o r when the r e is i n f ecti o n p r ese n t Suc t io n i n g acti v a t es p sy cho l o gi c al and p h y s iologi c al r e f l e x es th a t ma k e the e xpe r i ence both un c om f or t abl e and fr ig h t en ing Nu r s i n g Ca r e - Suct i on i ng

12. Th e major i ty o f t r ach t u be s h a v e i n ner c ann u las th a t r equ i r e clea n i n g one t o th r e e times d aily un le s s th e y a r e d i s posab le U s e s t eril e t echniqu e t o clean the r eusab l e c annu l a with ½ s t r en g th h y d r o g en pe r o x i d e and norma l sa l i ne Mai nt enance o f t h e i nne r c annu l a

13. Cu f f p r essu r e (ba ll o on) shoul d b e ma i n t ai ne d a t 20 mmHg o f p r essu r e via a mano me t er – shoul d be assess e d da il y; if y o u d o n ’ t h a v e a mano me t er measur ing d e vi ce – check With a s t e thos c op e p laced o n the neck , i n f l a t e the cu f f u n til y o u n o lo n g er hea r h i ss i ng; d e f l a t e the c u f f in ti n y i nc r eme n ts u n til a s lig h t h is r e tu r ns… . Nu r s i n g C a r e – T r ach cu f f p r essu r e

14. T u be chan g es c an be don e s a f ely o n a 1 -3 mo n th bas is usin g a clean t echn i que S i l i c o n tu b es c an c r a c k and t ear; sof t P V C tu b es c an s ti f f en with ti m e Nu r s i n g Ca r e: Chang i n g the T r ach tube

15. C l ean st om a with Q - tip moi s t e n ed with NS; A v o id us i ng h y d r o gen pe r o x i de un l ess i n f ect i on p r ese n t (a s i t c an impa i r heal i ng) – D r ess ing s a r ound the s t om a a r e chan g ed N u r s i n g c a r e: T r a c heo s t o m y S i t e Ca r e and D r ess i ng

16. Aftercare After tracheostomy care is finished, the soiled dressing and supplies should be discarded, either in the garbage or in a biohazard container if there is a large amount of blood . The patient may need to be suctioned again, and his or her respiratory status should be reassessed. Again, pain medication should be offered as appropriate.