A tracheostomy is a medical procedure — either temporary or permanent — that involves creating an opening in the neck in order to place a tube into a person’s windpipe. The tube is inserted through a cut in the neck below the vocal cords. This allows air to enter the lungs. An opening made in anterior wall of the trachea and converting into a stoma on skin surface.
WHY DO WE DO A TRACHEOSTOMY?
• Upper airway obstruction
• Prolonged intubation
• Difficult intubation
• Protection of airway
• Preventing aspiration
• Tracheal toileting
HOW DOES A TRACHEOSTOMY HELP?
• Decreased work of breathing
• Less aspiration risk
• Better removal of secretions
• Improved patient comfort
• Less sedation required
• Better oral care and swallowing
• Better communication
HOW TO TAKE CARE OF A TRACHEOSTOMY ?
1. Trachea & Lungs
2. Stoma or Wound
3. Tracheostomy Tube
1. TAKING CARE OF THE TRACHEA AND LUNGS
d. Secretion Explusion
CARE OF THE CUFF
• Cuffed tubes allow positive pressure ventilation and prevent aspiration.
• If the cuff is not necessary for those reasons, it should not be used.
• It irritates the trachea and provokes and trap secretions, even when deflated.
• Cuffs should be deflated regularly (four times a day) for 3 to 5 minutes to prevent pressure necrosis.
To remove mucous from the airway, to allow easier breathing, and prevent infections.
• Visible secretions at the tube opening
• Cough with the sound of secretions in the tube
• Rapid or laboured breathing
• Noisy breathing- 1. Air bubbling through secretions 2. Dry whistling
• Clear the catheter by suctioning saline through it
• Dispose the catheter or keep the tube in the diluted savlon bottle
• Always keep the diluted savlon bottle with the catheter and saline bottle the bedside
• Usually achieved while on oxygen as it is humidified
• HME ( heat and moisture exchangers)
• If the patient does not require oxygen, a thermovent T tube can be connected
• Alternatively, the tube can be covered with a wet gauge
• Using a room humidifier
• Keeping a kettle of boiling water in the room.
• Chest Physiotherapy
• Pharmacological agents like bromhexine, terbutaline
• Swallowing therapy
2. TAKING CARE OF THE STOMA
• Infection can enter from surface to lung or vice versa.
• Incision site can itself get infected
• Dressing once in 24 hours or if the dressing gets soiled early.
3. TAKING CARE OF THE TUBE
• Change the tube tie if loose. Do not take chance
• Tie should not be too tight or loose
• Tie should be tight enough to allow two fingers beneath the knot
• Check the patency of the tube by checking the airblast.
• Place the tip of the gauge piece near the tube opening. If tube is patent, there is a very good movement of the gauge end.
• Tubes with separate inner canula, it should be regularly removed and cleaned
4. TAKING CARE OF THE PATIENT
• Always keep a handbell near the patient alone with a writing pad and paper
• Never ignore the vitals. Regularly monitor temperature, pulse, BP and SpO2.
• Also look at the general condition of the patient. If the patient is tense and anxious, tube may be blocked
• Always keep a tracheostomy tube handy in case emergency tube change is needed
In case of emergency
• DO NOT PANIC
• Stimulate the patient, shout for help
• Suction and clear the blockage
• Deflate the bulb if its inflated
• In case of inner cannula, remove it
• Start oxygen and monitor the SPO2
• If no respiratory effort, start mannual ventilation
• Resuscitation and tube change as required and as per doctors advice