Rle - Tracheostomy Care

TRACHEOSTOMY CARE TEMPORARY VS PERMANENT
A. TEMPORARY
HISTORY
• Tracheotomy was first depicted on
Egyptian artifacts in the Bydos and
Sakkara regions of Egypt around 3600 BC.
ANTONIO MUSA BRASAVOLA
• Performed the first documented case
of a successful tracheotomy
• Published his account in 1546
HABICOT
• Performed the first pediatric
tracheotomy in 1620
FRIEDRICH III, GERMAN EMPEROR (1831 –
1888) • The upper airway will remain
• suffered larynx cancer misdiagnosed connected to the lower airway if the
by Morell Mackenzie, leading to tracheostomy tube were to be
suffocation. dislodged
• A tracheotomy was performed on B. PERMANENT
February 9, 1888, using a silver tube to
treat the tumor.
DEFINITION
• the formation of an opening into the
trachea usually between the second and
third rings of cartilage
PURPOSE
• Provide mechanical ventilation on a long-
term basis as in cases of neuromuscular
disease
• Facilitate weaning from mechanical
ventilation by decreasing anatomical dead
space
• To bypass obstruction: Cancer larynx
• To maintain an open airway: A comatose
• The larynx is removed and no
patient
connection exists between the upper
• To remove secretions more easily: Inability airway and the trachea itself
to swallow or cough: stroke patient
• Trachea is permanently disconnected
TYPES from the pharynx and the proximal
A. SURGICAL TRACHEOSTOMY end of the trachea is sutured to the
B. PERCUTANEOUS DILATATIONAL skin
TRACHEOSTOMY • Involves the removal of the larynx,
such as a laryngectomy or
laryngopharyngectomy
COMPLICATIONS A. CUFFED TUBE
SHORT TERM
A. SUBCUTANEOUS EMPHYSEMA
• Air escapes around stoma
B. DISLODGEMENT
• Due to excessive manipulation of the
tracheostomy tube
LONG TERM
A. TRACHEAMALACIA
• Thinning of trachea
B. DEVELOPMENT OF GRANULATION OF
TISSUE • Consists of three parts:
• Bump formation in trachea. 1. Outer cannula with an inflatable
C. NARROWING OF THE AIRWAY ABOVE THE cuff and pilot tube
SITE OF TRACHEOSTOMY 2. An inner cannula
D. OPENING MAY NOT CLOSE ON ITS OWN 3. An obturator
E. DYSPHAGIA B. CUFFLESS TUBES
F. TRACHEAL ISCHEMIA AND NECROSIS
AIMS OF THE HEALTHCARE IN THE • More suitable for long term ventilation
OPERATING ROOM • patient must have effective cough and
1. SAFE gag reflex to prevent aspiration risk
• “Don’t hurt me” C. POST-OPERATIVE PHASE
2. EFFECTIVE
• “Don’t kill me”
3. PATIENT-CENTERED
• “Don’t leave me helpless”
4. TIMELY
• “Don’t make me wait
TRACHEOSTOMY PARTS
• Have an opening on the posterior wall
of outer cannula allowing air to flow
through the upper airway and hence
allows patient to speak
• Often used during weaning process
COMMUNICATION AND
TYPES OF TRACHEO TUBE
TRACHEOSTOMIES • Frequent repositioning,
• Patients being weaned off trach tubes • Deep breathing and coughing
may have either a cuffless or fenestrated • Chest physiotherapy
tube to allow airflow past the larynx • Oral and parenteral hydration
• Supplemental humidification
NURSING CARE: EXAMINATION
• Be aware of when and why the trach was NURSING CARE: SUCTIONING
inserted , how it was performed, the type • Necessary for all trach patients to remove
and size of tube inserted secretions
• Examine the patient at the start of visit. • Routinely done 2x / day, but more often if
• Observe for signs of hypoxia, infection or a newly placed tracheostomy or when
pain there is infection present
• Chest: Auscultate breath sounds • Suctioning activates psychological and
• Examine trach tube, as well as stoma site physiological reflexes that make the
for redness, purulent drainage, and experience both uncomfortable and
bleeding around the stoma frightening
TRACHEOSTOMY HUMIDIFICATION SELECTING A SUCTION CATHETER
• ROOM TEMP: 22C, 10mmH2O/L • Selection of the appropriate size suction
• LARYNX: 31-33C, 26-32 mmH2O/L • catheter is vital in reducing the risk of
• MID-TRACHEA: 34C, 34-38 mmH2O/L trauma during suctioning
• MAIN BRONCHI: 37C, 44mmH2O/L • Divide the internal diameter of the
• The nose provides warmth, moisture and tracheostomy by two, and multiply the
filtration for the air we breath. answer by three to obtain the French
• Having a tracheostomy tube by-passes gauge suction catheter
these mechanisms • Size 8 tracheostomy tube (patient);
• Humidification must be provided to keep (8mm/2) x 3 = 12; therefore, a size 12F
secretions thin and to avoid mucus plugs gauge catheter is suitable for
TYPES OF HUMIDIFICATION SYSTEMS suctioning
1. AMBIENT WATER HUMIDIFICATION
EQUIPMENT
• PPE – (mask, goggles, gloves)
• Bottle of normal saline
• Appropriately sized suction catheter
• Trach care kit
2. HEAT MOISTURE EXCHANGER • Disposable inner cannula if appropriate
• Oxygen source – connected to patient
• Suction equipment regulator set at 80-120
mmHg
• Ambu bag to ventilate patient prior to
suctioning if appropriate
• attached to the outside of a trach tube

for longterm trach patient
• Looks like a t-tube attachment
SUCTIONING PROCEDURE
NURSING CARE: HELP TO THIN AND
• Place patient in semi-fowler’s position
MOBILIZE SECRETIONS
• Select appropriate sized suction catheter NURSING CARE: CHANGING TUBE
• Hyper oxygenate BEFORE each suction • Tube changes can be done safely on a 1-3
pass (except patients with long-term month basis using a clean technique
tracheostomy) • Silicon tubes can crack and tear; soft PVC
• Insert catheter to a pre-measured depth tubes can stiffen with time
• Apply suction on withdrawal of catheter
NURSING CARE: SITE CARE AND
• Limit suctioning to 5 seconds
DRESSING
• Use suction pressure between 80 – 120
• Clean stoma with Q-tip moistened with
mmHg
NS;
• Limit suctioning to 3 passes.
• Avoid using hydrogen peroxide unless
• Discontinue if HR drops by 20; infection present (as it can impair healing)
increases by 40, produces • Dressings around the stoma are changed
arrhythmias, or decreases 02 < 90%
FAQS
• Can a patient eat with a Tracheostomy?
TRACHEOSTOMY TIES o Yes…generally speaking (patient may
• Ties are generally changed daily need an evaluation by a speech
• To lower the risk of accidental trach tube pathologist to determine swallowing
coming out, tie changes should be:- ability).
performed by two people or with new ties • What is the tracheostomy plug Used for?.
secured BEFORE old ties are removed. o Decannulation of the tracheostomy
tube
MAINTENANCE OF THE INNER CANNULA ▪ Used to plug trach tube for 12
• The majority of trach tubes have inner hours the first day and 24 hours
cannulas that require cleaning one to the second day
three times daily unless they are ▪ if the patient tolerates plugging,
disposable then decannulation can take place
• Use sterile technique to clean the reusable o It can be used for speech, but not as a
cannula with ½ strength hydrogen speaking valve
peroxide and normal saline
NURSING CARE: TRACH CUFF PRESSURE

• Cuff pressure (balloon) should be
maintained at 20 mmHg of pressure via a
manometer – should be assessed daily;
• if you don’t have a manometer measuring
device – check With a stethoscope placed
on the neck, inflate the cuff until you no
longer hear hissing; deflate the cuff in tiny
increments until a slight his returns
PURPOSE
• Assess and evaluate how the cuff is
working
• Periodically relieve pressure on the
trachea
• Let secretions above the cuff drain down
so you can suction them

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TRACHEOSTOMY CARE TEMPORARY VS PERMANENT

• attached to the outside of a trach tube

NURSING CARE: TRACH CUFF PRESSURE

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