Tracheostomy Care for Nursing Staff

Tracheostomy Care for Nursing Staff

1. Tracheostomy Care Dr . Mayank Kumar, MBBS, MS Consultant ENT Surgeon

2. Tracheostomy Care What is a “Tracheostomy”? Types of Tracheostomy Types of Tracheostomy Tubes Physiological Changes due to Tracheostomy Nursing Care Changing of Tracheostomy Tube Emergencies & their Management Immediate/Early Postoperative Complications Late Decannulation & Stoma Closure

3. What is a “Tracheostomy”? A tracheostomy is a short surgical procedure in which an ENT surgeon places a tube for breathing into the patient’s trachea (windpipe) in the neck. The reasons may include: bypassing a blockage in the upper airway, to assist patient who cannot cough out the mucus from their lungs (lower airway toileting), and to aid a patient who needs to be on a ventilator for a long time.

4. What is a “Tracheostomy”?

5. Types of Tracheostomy Elective vs Emergency Temporary vs Permanent Open/Surgical vs Percutaneous /Dilatational

6. Types of Tracheostomy Tubes Disposable vs Reusable Metallic vs Non-metallic Single cannula vs Dual cannula Cuffed vs Cuffless / uncuffed / noncuffed /plain Adjustable flange vs Fixed length Solid vs Fenestrated Rigid vs Flexible With or without Suction port, etc .

7. Other Parameters Material Angulation Size Jackson sizing system International Standards Organization (ISO) sizing system: Inner diameter of the outer tube Cuff – Low-pressure , high-volume Barrel-shaped Foam-type Tear-drop shaped

8. Brands Portex Shiley TRACOE Bivona Arcadia

9. Gunmetal Tubes Jackson’s Tube Outer cannula/tube Inner cannula/tube Obturator

10. Gunmetal Tubes Fuller’s Tube Outer bivalved/biflanged tube Inner fenestration tube

11. Portex Tracheostomy Tubes Smiths Medical Flexible thermosensitive polyvinyl chloride ( PVC) with silicone coating Provides sufficient rigidity for initial insertion, and then softens at body temperature to accommodate individual patient anatomy Obturator Suction Aid Blue Line

12. Portex Tracheostomy Tubes Plain tubes Cuffed tubes Cuffed tubes with suction port

13. Physiological Changes due to Tracheostomy Loss of air conditioning – warming, moistening, filtering effects of nose Reduction in physiological dead space Loss of voice Loss of glottic hold (Inability to strain)

14. Nursing Care Call-bell Pen & paper Local hygiene – Keep dry – Stoma care Warm humidification Wet gauze Steam HME Suction Periodic cuff deflation

15. Suction Why? Excessive mucous Ineffective cough How frequently? When? Noisy breathing (the sound of air bubbling through secretions, or a dry whistling) Visible secretions at the tracheostomy tube opening Cough with the sound of secretions in the tube Rapid breathing or laboured breathing Restlessness, crying in a child How? Mask

16. Suction

17. Cuffed Tracheostomy Tubes Why the cuff? Bleeding Assisted ventilation Aspiration Disadvantages of cuff Pressure on tracheal walls Suprastomal sump/collection Voice? Periodic cuff deflation Every 2 hours – for at least 5 minutes Avoid deflation in first 6-8 hours after tracheostomy

18. Changing of Tracheostomy Tube When? Every1-4 weeks How? Mask Patient’s position Suction & cuff deflation Old tube removal Local antiseptic cleaning – followed by drying New tube preparation; cuff inflation & deflation Tube insertion – from the side; jelly? Remove obturator / stilette , secure tube & inflate cuff Repeat suction, if required

19. Changing of Tracheostomy Tube

20. Emergencies & their Management Immediate/Early Postoperative Complications Late

21. Emergencies & their Management Tube blockage Desaturation Noisy breathing Stridor Laboured breathing / dyspnoea / respiratory distress Tube dislodgement / false tract Bleeding Through the tube? Around the tube? Excessive secretions Through the tube? Around the tube? Subcutaneous emphysema Aspiration / dysphagia ?

22. Emergencies & their Management When in doubt? Call me & ask!

23. Decannulation & Stoma Closure When? Complications Difficult decannulation Downsizing Role of fenestration? Roll of cuff? Tracheocutaneous fistula

24. Any questions?

25. Thank you.