Tracheostomy Care

By: Pasal, Jane Dear Sualan, Abbot King Paraguya, ReyAnne Sadicon, Sean

What is Tracheostomy?
A tracheostomy is an opening (made by an incision) through the neck into the trachea (windpipe). A tracheostomy opens the airway and aids breathing. A tracheostomy may be done in an emergency, at the patients bedside or in an operating room. Anesthesia (pain relief medication) may be used before the procedure. Depending on the persons condition, the tracheostomy may be temporary or permanent.

When is tracheostomy needed?

A tracheostomy may be performed for the following conditions: Obstruction of the mouth or throat Breathing difficulty caused by edema (swelling), injury or pulmonary (lung) conditions Airway reconstruction following tracheal or laryngeal surgery Airway protection from secretions or food because of swallowing problems Airway protection after head and neck surgery Long-term need for ventilator (breathing machine) support

Metal Tracheostomy Tube

Indication: Not used as frequently anymore. Many of the patients who received a tracheostomy years ago still choose to continue using the metal tracheostomy tubes.

CuffedTube with Disposable Inner Cannula Indication: Used to obtain a closed circuit for ventilationCuff should be inflated when using with ventilators. Cuffed Tube with Reusable Inner Cannula

Indication:
Used to obtain a closed circuit for ventilation

 Cuffed Tube with Reusable Inner Cannula Indication: Used for patients with tracheal problems Used for patients who are ready for decannulation Fenestrated Cuffed Tracheostomy Tube Indication: Used for patients who are on the ventilator but are not able to tolerate a speaking valve to speak

Providing tracheostomy care

Explain procedure to patient If tracheostomy tube has been suctioned, remove soiled dressing from around tube and discard with gloves on removal. Perform hand hygiene and open necessary supplies

Cleaning A Nondisposable Inner Cannula

Perform hand hygiene and open necessary supplies. Prepare supplies before cleaning inner cannula. Open tracheostomy care kit and separate basins, touching only the edges. If kit is not available, open two sterile basins. Fill one basin fraction -inch (1.25 cm) deep with hydrogen peroxide. Fill other basin fraction -inch (1.25 cm) deep with saline. Open sterile brush or pipe cleaners if they are not already in cleaning kit. Open additional sterile gauze pad.

 Don disposable gloves. Remove oxygen source if one is present. Rotate lock on inner cannula in a counterclockwise motion to release it. Gently remove inner cannula and carefully drop it in basin with hydrogen peroxide. Remove gloves and discard. Clean inner cannula. Don sterile gloves. Remove inner cannula from soaking solution. Moisten brush or pipe cleaners in saline and insert into tube, using back-and-forth motion.

 Agitate cannula in saline solution. Remove and tap against inner surface of basin. Place on sterile gauze pad. Suction outer cannula using sterile technique. Replace inner cannula into outer cannula. Turn lock clockwise and make sure that inner cannula is secure. Reapply oxygen source if needed. Replacing Disposable Inner Cannula Release lock. Gently remove inner cannula and place in disposable bag. Discard gloves and don sterile ones to insert new cannula. Replace with appropriately sized new cannula. Engage lock on inner cannula.

Applying Clean Dressing and Tape

Dip cotton-tipped applicator in saline and clean stoma under faceplate. Use each applicator only once, moving from stoma site outward. Apply hydrogen peroxide to area around stoma, faceplate, and outer cannula if secretions prove difficult to remove. Rinse area with saline. Pat skin gently with dry 4 x 4 gauze. Slide commercially prepared tracheostomy dressing or prefolded non-cotton-filled 4 x 4 dressing under faceplate. Change tracheostomy tape.

 Leave soiled tape in place until new one is applied. Cut piece of tape that is twice the neck circumference plus 4 inches (10 cm). Trim ends on the diagonal. Insert one end of tape through faceplate opening alongside old tape. Pull through until both ends are even. Slide both tapes under patients neck and insert one end through remaining opening on other side of faceplate. Pull snugly and tie ends in double square knot. Check that patient can flex neck comfortably.

 Carefully remove old tape. Reapply oxygen source if necessary. Remove gloves and discard. Perform hand hygiene. Assess patients respirations. Document assessments and completion of procedure.

End.
Thank you and have a good day!!!!!