Tracheostomy tube Care by Dr. Ali Zain Raza

Tracheostomy care for doctors and nurses

1. TracheostomyCare
Guidelines
Essential procedures for performing
tracheobronchial suction and
tracheostomy careto minimize
complications and ensure patient safety.
AZby Dr. Ali Zain

2. When to Perform
Tracheobronchial
Suction
1
Assessment-Based
Perform suction only when
necessary, not routinely.
Base decision on accurate
respiratory assessment.
2
Professional Judgment
Use experience to select
techniques meeting specific
patient needs.
3
Evidence-Informed
Suction has potential
complications. Follow
evidence-based practice to
avoid problems.

3. Equipment for Tracheobronchial Suction
Primary Equipment
•Suction pump (wall/portable)
•Suction tubing/Yankauer
•Appropriate-sized catheters
•Sterile gloves
Vacuum Pressure
Use lowest possible vacuum pressure:
13-16 kPA/100-120 mmHg for adults.
Higher pressure doesn't improve
aspiration efficiency.
Catheter Size
Should be less than half the
tracheostomy tube diameter.
Quick calculation: Add 4 to current
tube size.

4. Proper Suction Technique
Preparation
Decontaminate hands, position
patient, explain procedure, and
administer supplementary
oxygen if indicated.
Catheter Insertion
Insert catheter without applying
suction until cough reflex is
elicited or resistance felt.
Withdraw 1cm. Never touch the
carina.
Suction Application
Apply suction only during
withdrawal. Duration must not
exceed 10 seconds to prevent
mucosal damage and hypoxia.
Completion
Dispose of catheter, rinse tubing
with sterile water. Use clean
catheter for each intervention.

5. Observations and Hazards
Monitor Closely
•Oxygen saturation
•Respiratory rate and pattern
•Heart rate
•Sputum characteristics
Potential Hazards
•Cardiac arrhythmias
•Infection
•Hypoxia
•Atelectasis
•Trauma
•Pneumothorax

6. Changing Tracheostomy Tubes
1
First Change
First outer tube change occurs 5 days after surgery to allow tract
formation. Exceptions include mini-tracheostomies and adjustable
flange tubes.
2
Subsequent Changes
Ideally should be replaced every 29 days. Tubes without inner cannula
require weekly changes.
3
Personnel
This is a 2-person procedure. At least one person must be
experienced, confident, and competent at changing tracheostomy
tubes.
4
Monitoring
Continuous monitoring of vital signs and pulse oximetry throughout the
procedure is essential.

7. FenestratedTubes and Cuff Management
Fenestrated Tubes
•May be cuffed or uncuffed
•Used for weaning and phonation
•Supplied with two inner cannulae
•Risk of granulation if tube
doesn't fit well
Suctioning Precaution
Always remove fenestrated inner
cannula before tracheal suction and
replace with unfenestrated inner
cannula to prevent tracheal wall
damage.
Cuff Management
Check cuff pressure twice daily,
maintaining between 15-20 mmHg.
Daily deflation recommended to
check pressure and remove
collected secretions.

8. Tracheostomy Wound Care
Daily Assessment
Assess peri-stomal skin integrity daily. Look for infection, excessive
moisture, pressure points, and over-granulation tissue.
Dressing Change
Change dressings as needed based on exudate amount. Use pre-cut dressings like
Lyofoam Toppers, Metalline, or 3M's.
Cleaning Procedure
Clean with normal saline, pat dry, and assess skin. Apply skin barrier if required.
Document all observations.
Post-Decannulation Care
Continue aseptic wound care until site heals completely. Have patient press onto
wound when speaking or coughing.

9. Communication and Swallowing
Communication Options
Use alphabet boards, coded eye-blinks,
lip-reading, electronic larynx, or writing.
Speech therapists can assess for
appropriate aids.
1
Voice Production
Achieve through cuff deflation,
fenestrated tubes, smaller tubes, finger
occlusion, or one-way speaking valves.
2
Swallowing Assessment
Patients with tracheostomies may
experience swallowing difficulties. Initial
assessment with sips of water before
normal diet.
3
Risk Factors
Neurological injury, disuse atrophy,
head/neck surgery, aspiration evidence,
increased secretions, and coughing during
intake.
4