Tracheostomy
Care
Shemil
Clinical Instructor
DM WIMS
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Tracheostomy Care & Management
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Objectives
1.Review of Evidenced-Based Guidelines in the Care &
Maintenance.
2.Review Definition, Types of Tracheostomies & their
uses.
3.Potential Complications.
4.Nursing Care.
5.Assessment.
6.Suctioning.
7.Dressing changes.
8.Inner cannula changes.
9.Other nursing considerations.
10.Documentation
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Definitions
Tracheotomy
Incision made below the cricoid cartilage through the
2nd-4th tracheal rings.
Tracheostomy
The opening or stoma made by this incision.
Tracheostomy Tube
Artificial airway inserted into the trachea.
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Anatomy
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Why does your patient have a tracheostomy?
To maintain a patent airway when the ability to do
this is temporarily or permanently compromised
Bypass Obstructed airway
a) Tumor
b) Laryngeal edema
c) Foreign body obstruction
Facilitate removal of secretions
Permit long-term ventilation/prevent aspiration with
prolonged coma
Decrease
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work of breathing---severe COPD 7
Parts of a Trach
1. Flange- secured with trach ties, stabilizes the trach.
2. Outer Cannula-tube connected to flange.
3. Inner Cannula- removable for cleaning.
4. Obturator-a plastic guide with a smooth rounded tip
that is used to guide the outer cannula during insertion.
5. Cuff-Soft balloon around the end of the trach that
can06/06/18
be inflated to allow for mechanical ventilation. 8
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Types
1. Cuffed or Un-cuffed
2. Fenestrated or Non-fenestrated
3.Disposable or Non-disposable inner cannula
4.Metal Tubes
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Cuffed
Purpose:
• Increase or improve ventilation/oxygenation
•Prevent aspiration with feeding tubes, decreased
gag reflex, gastro-esophageal reflux
Identification:
DCT- disposable cannula
DFEN-
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Cuff Complications
Pressure from the cuff can cause damage the trachea
Necrosis
Low pressure cuffs are used
RT will inflate/deflate and monitor pressure
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Un-cuffed
Plastic or metal
Allows air to flow freely around the tracheostomy tube
through the larynx.
Reduces the risk of tracheal damage
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Fenestration
Permits speech through the upper airway when the
external opening is corked and the cuff is deflated.
Restores more of a normal airflow by allowing air
to pass up and down the airway from the nose &
mouth.
Allows secretions to be coughed out through mouth.
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Inner Cannula
Allows maintenance of tube patency.
Changing or cleaning the inner cannula helps to clear
secretions.
Can be non-disposable or disposable.
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Potential Complications
Hemorrhage
Pneumothorax
Subcutaneous emphysema
Dislodged tube
Airway obstructions
Infection
Aspiration
Tracheal
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Prevention is Key
Trach patients are at high risk for airway obstructions,
impaired ventilation, and infection as well as other
complications.
Altered body image, requiring emotional/psychological
support.
Skilled and timely nursing assessment and care can
prevent these complications.
Goals in care will include maintaining a patent airway
as well as ventilation/oxygenation:
Suctioning
Humidity
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Trach care & maintenance
Nursing Assessment
Beginning of each shift and prn.
Look and listen.
Vital signs & SpO2 – pulse oximetry.
Oxygen/Humidity.
Respiratory assessment = breath sounds.
Secretions- amount, color, consistency.
Cough, ability to clear own secretions.
Trach site.
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TRACHEOSTOMY
CARE
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Changing/Cleaning Inner Cannula
Non-disposable inner cannulas are cleaned with Normal
Saline,diluted hydrogen peroxide, rinsed off with N/S
remove excess fluid before re-inserting
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Disposable inner cannulas are replaced with trach
care Q8 hours & PRN
Trach ties-are changed only when wet or soiled
and 2 people should assist with this procedure---
Leave one finger between ties and neck--Velcro
hooks attach easily to tracheostomy tube flange.
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SUCTIONING
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Decision to Suction
Frequency of suction will vary and must be
individually assessed & not done on a schedule
Factors to Consider:
Is the pt able to cough &/or clear secretions?
Increased work to breath?
Changes to respiratory rate
Amount and consistency of secretions
Decreased O2 saturation
Secretions are audible
Pt request
Other Respiratory S & S (i.e. SOB, cyanosis,
restless,anxiety)
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Suctioning
Insert catheter until you meet resistance &/or pt coughs
forcibly then pull back slightly &start suctioning
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Procedure Considerations
Suctioning removes secretions, & also O2
Suction pressure too high (>120mmHg) can cause
mucosa damage & bleeding.
Suction pressure too low may not clear secretions & be
ineffective
Suction mouth with a (yankauer) not the same suction
catheter as trachea to avoid cross contamination
Do not apply suction while inserting the catheter
May be necessary to pre-oxygenate the patient prior to
and after suctioning
Use personal protective equipment (i.e. goggles,
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mask,face shield)
Suctioning
Pre oxygenation
Test suction pressure before instilling catheter 60-120 mm Hg
Suction catheter: £ ½ diameter of tube
Prepare clean cup with NS to lubricate and clear secretions from
suction catheter
Dominant hand remains sterile with clean glove, and will be
inserting the catheter, while the non-dominant gloved hand grasps
the suction port
Apply suction only on removal of catheter no during insertion
Suction efficiently and quickly depending on secretion
amount,consistency.
Each suction should not exceed more than 10 seconds
Do not exceed 3 attempts and allow 20 to 30 seconds between
each, oxygenate pt between PRN
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Post oxygenation
Replace all the articles
keep ready articles for next suction
Wash hands
Document the procedure.
Continue patient assessment.
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Complications with Suctioning
Hypoxemia—dysrhythmia
Atelectasis or lung collapse
Mucosal trauma/damage---bleeding
Broncho spasm
Dysrhythmias
Nosocomial pulmonary tract infection
Sepsis
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Cardiac arrest
TRACHEOSTOMY
DRESSING
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CLOSED SUCTION
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