TRACHEOSTOMY

CARE
SANIYYA AHMED
2nd YEAR M.Sc. NURSING
AMRITA COLLEGE OF NURSING
AIMS / KOCHI
 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
 TRACHEOSTOMY
SPEAKING
VALVE
● The valve provides low resistant one-
way airflow using a thin silicone
diaphragm that opens on inspiration and
closes on expiration
 TRACHEOSTOMY
SPEAKING
●
VALVE
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
 TRACHEOSTOMY
SPEAKING
●
VALVE
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
 COMPLICATIONS
Immediate:
● Hemorrhage
● Hypoxia
● Trauma to recurrent laryngeal nerve
● Damage to esophagus
● Pneumothorax
● Infection
● Subcutaneous emphysema
 COMPLICATIONS
Early:
● Tube obstruction or displacement
● Pooling of secretions leading to aspiration
● Bleeding from tracheostomy site
● Infection
 CARE
Stoma 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
 CARE
Tube 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
 CARE
Suctioning
● 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
 CARE
Hazards of suctioning
● Patient anxiety
● Changes in ICP
● Trauma
● Infection
● Pneumothorax
● Hypoxia
● Cardiac hazard
 CARE
Humidification
● 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
 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
 NURSING MANAGEMENT
● The patient and all hospital staff will
demonstrate and apply hand washing
technique through hospitalization
● the nurse educate the patient and his family
about transmission of infection after discharge
● assess and maintain for adequate humidity of
inspired air every two hours
 NURSING MANAGEMENT

● 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