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Tracheostomy Care
Tracheostomy Care
Tracheotomy
It is an artificial opening made in the trachea into which a tube is
inserted to establish and maintain a patent airway.
Purpose
1. To provide an airway when there is obstruction in the upper airway.
2. To aid in removal of tracheobronchial, secretions
3. To avoid aspiration of secretions, food and/or fluids into the lungs.
4. To replace an endotracheal tube when long term or permanent
airway provision is required.
5. To facilitate the use of respirator to ventilate the lungs.
Supplies
1. A sterile tray containing
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
sizes (large, medium, and small size) taped and with pilot
m)Syringe and needle for local anaestheia
n) Dressing towels and towel clips
o) Sponge holding forceps, Cotton pad, gauze pieces and cotton
balls,
p) Gowns, gloves and masks
2. A clean tray containing
a. Protective sheet and towel
b. Local anaesthesia i.e lignocaine 2 percent
c. Sterile vaseline gauze in container
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d.
e.
f.
g.
a)
h.
Guidelines
1. Tracheostomy may be indicated in
a) Conscious patients with upper airway obstruction e.g. tumours,
stenosis, oedema of larynx and trachea and foreign bodies.
b) Unconscious patients with inadequate ventialtion e.g. respiratory
depression.
c) Patients with severe burns especially around face and neck.
d) Patients with head, neck and chest injuries. The airway obstruction
may result from haemorrhage, oedema, muscular and nerve
paralysis, sub mucosal haematoma, subcutaneous emphysema etc.
e) Patients with respiratory failure who require respiratory assistance
for periods longer than 1 to 2 days especially when a respirator is to
be used.
f) Patients with trauma and paralysis of larynx and trachea, severe
pulmonary oedema and emphysema.
g) Patients receiving irradiation therapy for laryngeal tumours.
h) Patients with fulminating infections of the mouth, pharynx or throat
e.g. diphtheria, poliomyelitis and tetanus.
i) Patients
with
accumulation
of
secretions
in
the
lower
mandibulectomy,
laryngectomy,
radical
neck
resection etc.
l) Post operative patients with laryngeal oedema due to prolonged
intubation or when endotracheal tube cannot be inserted or it is
contraindicated. m. Weak, feeble or critically ill patients to reduce
the work of breathing.
2. Tracheostomy may be classified into
New Born
uptol year
1 to 3 years
3 to 6 years
6 to 12
12 to
Adult
diameter) of tracheostomy
tube
4.5 mm
5.5 mm
6.0 mm
7.0 mm
8.0 mm
9.0 mm
9-11 mm
catheter
5-8 Fr.
8Fr.
10 Fr.
12 Fr.
14 Fr.
16-18Fr.
18 Fr.
asphyxia.
The
reasons
are
same
as
for
tracheo-
esophageal fistula
h) Subcutaneous emphysema due to escape of air into the tissues,
i) Injury to the tracheal wall and adjacent structures due to rough
handling of tracheostomy tube during suctioning and changing
tube procedures,
j) Prolonged suctioning of tracheostomy tube reduces oxygen
content causing hypoxia and cardiac arrest.
7. Do not leave any plastic bags, papers, clothes etc. nearby, if
the patient is child as it may pull them over the tracheostomy
opening and obstruct the airway
Nursing Activity
1) Assemble and arrange the supplies urgently at the bedside if it is
to be performed as an emergency procedure and screen the bed.
2) Explain the procedure to the patient and his or her relatives.
3) Get the written consent from the relative.
4) Cover the patient with a cover sheet and fanfold the top clothes
to the foot end of the bed.
5) Remove the upper garments and put on a gown.
6) Adjust the position of the bed to a comfortable working height
and move the patient to the edge of the bed.
7) Position the patient flat on his or her back with a pillow under the
shoulders to tilt the head and neck to hyperextend. Use
restraints, if necessary to maintain the position and keep the
head and neck in a straight line.
8) Place the protective sheet and towel under the head and neck of
the patient.
9) Adjust the light to have sufficient light on the part
10)
Wash your hands
11)
Put on mask, gown and gloves.
12)
Assist the doctor as needed to perform tracheostomy.
13)
Assist to suck the secretions and blood thoroughly.
14)
neck.
15)
Postoperatively
amount,
of secretions.
month care.
oxygen administration.
steam inhalation.
2. Note the time and amount of fluid intake in the intake and
output chart.
GIVING TRACHEOSTOMY CARE
Purpose
1. To keep the airway patent.
2. To reduce the respiratory infections.
3. To help the patient learn to take care of tracheostomy especially
when permanent tracheostomy is performed.
Supplies
Sterile Supplies
1. Half way cut gauze pieces, ties/tapes, cotton swabs, cotton pads
2. Applicators
3. Bowls-2
4. Gloves-2 pairs
5. Small brush with fine bristles.
Clean Supplies
1. Hydrogen peroxide (1/2 strength)
2. Sterile sodium bicarbonate 2 percent or normal saline
3. Any non-irritating cleansing solution
4. Vaseline and antibiotic ointment e.g. soframycin
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the underlying cause is removed. Before removing, the opening is closed for a varying length of time and observed for any
untoward signs. If the patient feels no difficulty, remove, the
tube. Observe the patient for 24-48 hours for any respiratory
distress following the tube removal.
12) A patient with permanent tracheostomy is given following
instructions.
a) Take care of the tracheostomy tube. Demonstrate the
procedure to the patient and take return demonstration.
b) What to do in case the tube gets dislodged. Avoid
accidental entry and aspiration of water, hair, cotton into
the stoma while taking bath or soap and water while
washing the face and also avoid swimming.
c) Take care while using after shave lotions on neck, or
powder or spray on face, neck and chest.
d) Inform the barber about the stoma while getting hair cut
done.
e) Prevent
respiratory
infections
by
taking
adequate
technique.
9) Put on clean gloves and remove the soiled tracheostomy dressing
and place in the paper bag.
10)
Cut and remove the soiled ties. Take the help of the other
person who will continually hold the tracheostomy tube with a
sterile gloved hand until new ties are securely placed. Place the
soiled ties in the paper bag.
11)
Remove the clean gloves and put on sterile gloves.
12)
Clean and sterilize the inner cannula, if present.
a) Unlock the inner cannula and remove.
b) Wash it under cold running water to remove the mucus
adhering to it.
c) Soak it in hydrogen peroxide and sodium bicarbonate 2
d)
e)
f)
g)
13)
10
16. Apply
little
antibiotic
ointment
on
the
skin
around
the
21.
Recordings
Note the following in the nurse's notes
1. Date and time of the procedure.
2. Colour, amount, consistency and odour of secretions.
3. Condition of incision.
4. Ointment applied to the skin around tracheostomy tube.
5. Vital signs and breath sounds.
6. Any instructions given to the patient and/or family and their level of
understanding.
BIBLIOGRAPHY
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