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TRACHEOSTOMY
It is a surgical opening in the anterior wall of the I trachea just below the larynx or is an
operative procedure that creates a surgical airway in the cervical trachea. A tracheostomy
may be performed as a permanent and emergency procedure

INDICATIONS
● To provide and maintain patient airway
● To enable the removal of
tracheo-bronchial secretions
● To permit long term positive pressure
ventilation
● To improve patient comfort
● To decrease the work of breathing and
increase volume of air entering the lungs

TYPES OF TRACHEOSTOMY TUBES

● Metal ● Plastic
● Cuffed ● Fenestrated

TRACHEOSTOMY SPEAKING VALVE

● Tracheostomy Speaking Valve is designed to allow tracheostomy patients to vocalize
without the need for finger occlusion
● The valve provides low resistant one- way airflow using a thin silicone diaphragm that
opens on inspiration and closes on expiration
● An exclusive feature of this valve is a cough-release mechanism eliminating valve or tube
dislodgement as a result of coughing or excessive airway pressure
● An exclusive feature of this valve is a cough-release mechanism eliminating valve or tube
dislodgement as a result of coughing or excessive airway pressure

CONTRAINDICATIONS
● Suspected CSF leak (BOS fracture) or raised intracranial pressure
● Tracheoesophageal fistula
● Cancer in upper GI or respiratory tract
● Oesophageal or high GI surgery

ANATOMICAL POSITIONING OF TRACHEOSTOMY TUBE

( diagram )

COMPLICATIONS
Immediate:
● Hemorrhage
● Hypoxia
● Trauma to recurrent laryngeal nerve
● Damage to esophagus
● Pneumothorax
● Infection
● Subcutaneous emphysema

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Early:
● Tube obstruction or displacement
● Pooling of secretions leading to
aspiration
● Bleeding from tracheostomy site
● Infection

CARE
● care towards hygiene and asepsis is necessary
● Remember the skin surrounding the stoma is also prone to irritation
● as per hospital policy and barrier cream applied to the local skin cotton wool should be
avoided
Stoma care
● Tubes need to be cleaned
● The area should be cleaned with
normal saline in double cannula the inner cannula will need to be removed and to be cleaned
● For cuffed tracheostomy tubes the pressure should be measured in every shift as per
hospital policy
Tube care
● Suctioning should be done PRN after chest PT and Nebulization
● Use the lowest pressure needed usually less than 120 mmHg and definitely not beyond 200
mmHg
● Suctioning should be performed less than 10 seconds
Suctioning

Hazards of suctioning
● Patient anxiety
● Changes in ICP
● Trauma
● Infection
● Pneumothorax
● Hypoxia
● Cardiac hazard

● The normal humidification and air filtration system is bypassed if the tracheostomy is in
situate
● Keep patients well hydrated- otherwise secretion will become thicker and will lead to
infection
Humidification

NURSING DIAGNOSIS
● Risk of ineffective airway clearance related to increase secretion secondary to
tracheostomy
● Risk for infection related to excessive pooling of secretion
● Impaired verbal communication related to inability to produce speech secondary to
tracheostomy

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NURSING MANAGEMENT
● The patient and all hospital staff will demonstrate and apply hand washing technique
through hospitalization
● the nurse educates the patient and his family about transmission of infection after discharge
● assess and maintain for adequate humidity of inspired air every two hours
● keep stoma free from any debris or mucous build up as needed
● check body vital signs
● keep patient with comfortable position
● give analgesic medication as order

THINGS TO REMEMBER
● DON'T PANIC
● STERILE TECHNIQUE
● SAFETY FIRST
● CRITICAL THINKING
● NUTRITION
● COMMUNICATION

BIBLIOGRAPHY
1. Jacob Annamma. Rekha. R. clinical nursing procedures the art of nursing practice.
2nd edition. Jaypee publications. New Delhi. 2007. P a g e no: 328-330.
2. Smeltzer et.al (2011), Brunner and Suddharths Textbook Medical Surgical Nursing.
Volume 1 12th Editions, Wolter Kluwer P t, New Delhi pp 778-793
3. S Mogotlane et.al (2009), Jutas Manual of Medical Surgical Nursing, Volume 4, 1st
Edition, pp. 18-16-18
4. Lewis et.al. (2009). Medical Surgical Nursing Assessment and Management Of
Clinical Problems.7th edition, Page No.810-71
5. Sands ' Phipps Medical Surgical Nursing Health and Illness Perspective, 8th Edition,
Page No.903-905