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    Tracheostomy Care

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    Kj Jean
    1. The document discusses tracheostomy care and management, including definitions, anatomy, types of tracheostomies, potential complications, nursing assessments, suctioning, dressing changes, and other considerations. 2. Key aspects of tracheostomy care include maintaining a patent airway, preventing complications like infection, assessing respiratory status and secretions, and performing procedures like suctioning and dressing changes. 3. Frequent nursing assessments and timely care such as suctioning, humidification, tracheostomy changes are important to prevent complications and maintain ventilation and oxygenation.

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    Tracheostomy Care

    Uploaded by

    Kj Jean
    386 views36 pages
    1. The document discusses tracheostomy care and management, including definitions, anatomy, types of tracheostomies, potential complications, nursing assessments, suctioning, dressing changes, and other considerations. 2. Key aspects of tracheostomy care include maintaining a patent airway, preventing complications like infection, assessing respiratory status and secretions, and performing procedures like suctioning and dressing changes. 3. Frequent nursing assessments and timely care such as suctioning, humidification, tracheostomy changes are important to prevent complications and maintain ventilation and oxygenation.

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    Tracheostomy’s by nurse

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    Tracheostomy care

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    1. The document discusses tracheostomy care and management, including definitions, anatomy, types of tracheostomies, potential complications, nursing assessments, suctioning, dressing changes, and other considerations. 2. Key aspects of tracheostomy care include maintaining a patent airway, preventing complications like infection, assessing respiratory status and secretions, and performing procedures like suctioning and dressing changes. 3. Frequent nursing assessments and timely care such as suctioning, humidification, tracheostomy changes are important to prevent complications and maintain ventilation and oxygenation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    386 views36 pages

    Tracheostomy Care

    Uploaded by

    Kj Jean
    1. The document discusses tracheostomy care and management, including definitions, anatomy, types of tracheostomies, potential complications, nursing assessments, suctioning, dressing changes, and other considerations. 2. Key aspects of tracheostomy care include maintaining a patent airway, preventing complications like infection, assessing respiratory status and secretions, and performing procedures like suctioning and dressing changes. 3. Frequent nursing assessments and timely care such as suctioning, humidification, tracheostomy changes are important to prevent complications and maintain ventilation and oxygenation.

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    Tracheostomy

    Care
    Shemil
    Clinical Instructor
    DM WIMS
    06/06/18 1
    Tracheostomy Care & Management

    06/06/18 2
    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
    06/06/18 in powerchart. 3
    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.
    06/06/18 4
    Anatomy

    06/06/18 5
    06/06/18 6
    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
    06/06/18
    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
    06/06/18 9
    Types
    1. Cuffed or Un-cuffed

    2. Fenestrated or Non-fenestrated

    3.Disposable or Non-disposable inner cannula

    4.Metal Tubes

    06/06/18 10
    Cuffed
    Purpose:

    • Increase or improve ventilation/oxygenation

    •Prevent aspiration with feeding tubes, decreased

    gag reflex, gastro-esophageal reflux

    Identification:

    DCT- disposable cannula

    DFEN-
    06/06/18 disposable cannula fenestrated 11
    Cuff Complications
    Pressure from the cuff can cause damage the trachea
     Necrosis
     Low pressure cuffs are used
     RT will inflate/deflate and monitor pressure

    06/06/18 12
    Un-cuffed
    Plastic or metal

    Allows air to flow freely around the tracheostomy tube

    through the larynx.

     Reduces the risk of tracheal damage

    06/06/18 13
    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.

    06/06/18 14
    Inner Cannula
    Allows maintenance of tube patency.
    Changing or cleaning the inner cannula helps to clear
    secretions.
    Can be non-disposable or disposable.

    06/06/18 15
    Potential Complications
     Hemorrhage

     Pneumothorax

     Subcutaneous emphysema

     Dislodged tube

     Airway obstructions

     Infection

     Aspiration

     Tracheal
    06/06/18 damage 16
    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
    06/06/18 17
     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.
    06/06/18 18
    TRACHEOSTOMY

    CARE

    06/06/18 19
    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

    06/06/18 20
     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.

    06/06/18 21
    SUCTIONING

    06/06/18 22
    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)
    06/06/18 23
    Suctioning

    Insert catheter until you meet resistance &/or pt coughs


    forcibly then pull back slightly &start suctioning
    06/06/18 24
    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,
    06/06/18 25
    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
    06/06/18 26
     Post oxygenation
     Replace all the articles
     keep ready articles for next suction
     Wash hands
     Document the procedure.
     Continue patient assessment.

    06/06/18 27
    Complications with Suctioning
    Hypoxemia—dysrhythmia

     Atelectasis or lung collapse

     Mucosal trauma/damage---bleeding

     Broncho spasm

     Dysrhythmias

     Nosocomial pulmonary tract infection

     Sepsis
    06/06/18 28
     Cardiac arrest
    TRACHEOSTOMY
    DRESSING

    06/06/18 29
    06/06/18 30
    06/06/18 31
    06/06/18 32
    06/06/18 33
    06/06/18 34
    CLOSED SUCTION

    06/06/18 35
    06/06/18 36

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