2021 - 2022 Tracheostomy Care Procedure

An Artificial Respiratory
Intervention
CON - LORMA SKILLS LABORATORY
2021 - 2022
shaiamariebautistamayo0809
TRACHEOSTOMY CARE
Trachea
• windpipe
• The adult trachea measures 10 - 13
cms from cricoid cartilage to the
carina (bifurcation of trachea).
• Tracheostomy at the 2-3rd tracheal
ring
Tracheostomy
• “trachea” (neck) +
“-ostomy” (opening)
• an artificial opening
in the trachea into
which a tube is
inserted
• A tracheostomy is a surgical procedure
to create an opening through the neck
into the trachea
• A tube is usually placed through this
opening to provide an airway and to
remove secretions from the lungs.
• This tube is called a tracheostomy tube
or trach tube.
History
• It is one of the oldest described surgical

procedure.
• It finds a mention in the Rig veda an ancient
Hindu text of medicine (1500 BC).
• Emperor Alexander was credited with
performing the first tracheostomy. He is said to
have performed this procedure on a soldier who
chocked himself with his sword.
• Jackson has been credited with documentation of
tracheostomy as a modern life saving procedure.
• The number of tracheostomies preformed underwent
a surge during the 18th and early 19th centuries due
to diptheria epidemics which caused upper airway
obstruction.
• The advent of intensive care units and presence of
ventilators during 1950s changed the status of
tracheostomy from a life saving emergency procedure
to that of a prolonged life supporting procedure.
Advantages of Tracheostomy:
1. The procedure permanently secures the airway.
2. The anatomical dead space is reduced.
3. Tracheostomy bypasses the upper airway and hence it
is useful in upper airway obstructions.
4. Suction can be applied through the tracheostomy and
bronchial secretions can hence be cleared.
5. If tube is used as tracheostomy tube it can be
connected to a ventilator thus assisting the process of
ventilation.
Disadvantages of Tracheostomy:
1. It is a surgical procedure and hence has morbidity and
mortality rates associated with surgical procedures.
2. The tracheostomy tube will have to be cleaned periodically.
3. During early phases periodical suction must be applied hence
hospital support is a must.
4. The patient may not be able to use the voice. Some
tracheostomy tube like the Fuller's metal tube may have a
speaking valve which could help the patient to speak, the
patient must get used to plugging the hole while speaking.
5. Decanulation is a complicated procedure.
Types of Tracheostomy:
1. Temporary tracheostomy
2. Permanent or end tracheostomy - this is done
in patients who have underwent total
laryngectomy.
3. Mini tracheostomy
4. Percutaneous tracheostomy
5. Cricothyroidotomy
DESCRIPTION
• General anesthesia is used. The neck is

cleaned and draped. Surgical cuts are
made to expose the tough cartilage
rings that make up the outer wall of
the trachea. The surgeon then creates
an opening into the trachea and inserts
a tracheostomy tube.
INDICATIONS
• An inherited abnormality of the larynx or trachea

• Cancer of the neck, which can affect breathing
• Severe neck or mouth injuries
• Breathing harmful material such as smoke or
steam
• A large object blocking the airway
• Paralysis of the muscles that affect swallowing
• Long-term unconsciousness or coma
TRACHEOSTOMY CARE
• Keeping the tracheostomy site
clean and dry preventing skin
irritation and infection.
• The respiratory tract is sterile and
thus the tracheostomy provides a
direct opening, meticulous care is
necessary
PURPOSES
1. Relief of acute or chronic upper airway
obstruction.
2. Access for continuous mechanical
ventilation.
3. Prevention of aspiration pneumonia.
4. Promotion of pulmonary hygiene.
5. Prolonged endotracheal tube insertion
resulting in erosion or pain.
EQUIPMENT
1. Sterile kidney basin, gauze and gloves
2. Hemostat, scissor, cotton tip swabs
3. Hydrogen peroxide, suction apparatus with sterile
catheter
4. Gown and facemask (optional)
5. Antiseptic solution and ointment (optional)
6. Suction unit with appropriate suction catheter
7. Bag-valve mask
TRACHEOSTOMY SET
PARTS OF THE TRACHEOSTOMY
SET
1. CUFF - the “balloon” on the end of the
tracheostomy tube. When inflated, it forms a seal
against the wall of your windpipe. This stops the
air flow through your mouth and nose so that you
breathe through the tracheostomy tube. You are
unable to speak when the cuff is inflated.
REASONS FOR USING A CUFFED TUBE :
1. provides a seal if using a breathing machine
(ventilator)
2. may prevent choking (aspiration) from nose or
mouth drainage
3. may prevent choking (aspiration) of food from the
stomach
2. INFLATION LINE - thin plastic tubing that
carries air to and from the cuff
3. CUFF PORT - a small, plastic balloonlike
component on the end of the inflation line.
The cuff port shows if the cuff is inflated. It is
also called a pilot balloon.
4. LUER VALVE - where the syringe is
connected to inflate or deflate the cuff
5. 15mm CONNECTOR - part of the tube or
inner cannula that sticks out at the neck.
Ventilator tubing, a manual resuscitation
bag, or a speaking valve may be connected to
the 15mm connector.
6. NECK FLANGE - usually contains product
information and has holes on either side for
securing neck ties.
* Tubes are made of metal or synthetic materials .
7. OUTER CANNULA– the tube that is inserted into
your windpipe. It stays there all the time and may
have another part (the inner cannula) that slides
inside of it.
8. INNER CANNULA - the tube that fits inside your
outer tracheostomy tube. It is removed for
cleaning or replacement.
9. OBTURATOR - a guide used to insert the
tracheostomy tube.
10. TRACHEOSTOMY TIES – Twill and Velcro
Ties
FENESTRATED TRACHEOSTOMY
TUBES
• A fenestrated tracheostomy tube has 1 hole or
several smaller holes along the outer cannula.
• When a person has a tracheostomy that is
fenestrated and has the outer opening of the
tracheostomy tube capped, breathing in and out
happens through the nose and mouth.
• Mucus is coughed up through the mouth.
• A person can talk because exhaled air passes
through the holes in the outer cannula up to the
vocal cords.
Why have a fenestrated tracheostomy tube?
1. Short-term use : Weaning with a
fenestrated tube lets your doctor see how
well you could breathe without the tube.
2. Long-term use : tube may be capped for
normal mouth and nose breathing and
speaking. (sleeping & suctioning).
3. Fenestrated tubes also may help
swallowing.
Important points about fenestrated
tubes:
1. Before the fenestrated tube is capped, the cuff
MUST be deflated. A person CANNOT breathe
with the cuff inflated and the tube capped.
2. If you have trouble breathing when the tube is
capped, REMOVE the cap immediately.
3. NEVER place the cap on the tube when the cuff
is inflated.
4. Do not cap a fenestrated tube until you’ve
received instructions and have practiced.
PREPARATIONS
Assess condition of  Evaluate to determine if the

the patient prior to patient can tolerate the
the care. procedure.
Assess condition or  Assess for redness, swelling, and

stoma prior to character of secretions, presence
tracheostomy care of purulence or bleeding. The
presence of skin breakdown or
infection must be monitored.
Culture of the site may be
warranted by appearance of
these signs.
NOTE: Prior to tracheostomy care
trachea and pharynx should be
suctioned thoroughly to keep the area
clean.
Explain the procedure to the  To reduce anxiety.
patient
Wash hands to reduce

microorganism transfer.
Place all the equipment on  Do not use solutions or

bedside table for easy chemical agents other
access without than those recommended
contamination. for every type of
tracheostomy as this may
result in the tube damage.
Fill the first kidney basin with
NSS and hydrogen peroxide
and the second kidney basin
with NSS.
Wear sterile gloves.
Pick-up one sterile gauze with

finger of sterile hand
Stabilize neck plate (or have an  To decrease
assistant to do so) discomfort and
trauma during
removal of cannula.
With sterile hand, use  Gently slide cannula
gauze to unlock inner out using an
cannula by turning OUTWARD and
COUNTER DOWNWARD
CLOCKWISE manner to follow the
curve of tracheostomy
tube, and place the
inner cannula to the
basin with NSS and
peroxide.
Suction outer cannula to  Have patient take a deep
remaining secretions breath (if conscious) or
use Ambu-bag to deliver
100% oxygen to provide
oxygenation after
suctioning.
Remove tracheostomy  To remove possible

dressing to expose skin for airway obstruction and
cleaning. medium for infection.
Using sterile gauze, wipe  A cotton applicator with
secretions from around Betadine maybe used if
the tube. the wound is infected.
Discard first sterile  To prevent the spread
gloves and put of microorganisms.
another sterile gloves.
Clean inner cannula by  Gauze can be

using sterile gauze to threaded through the
remove secretions inner cannula to
from outside and remove excess
inside of cannula. secretions and
solution.
Rinse inner cannula in basin with NSS then
wipe it with dry gauze to prevent
introducing fluid into trachea.
Slide inner cannula into outer cannula using

smooth inward and downward arch.
Hold neck plate stable with other hand and
turn inner cannula CLOCKWISE until
lock is felt.
Have assistant hold  Ties should be tight
tracheostomy neck enough to keep tube
securely in the stoma, but
plate while you
loose enough to permit
remove the tie. two fingers to fit between
Slip end of new tie the tapes and the neck.
through the holder on Excessive tightness of
neck plate and tie tapes will compress
square knot 2-3 inches jugular veins, decrease
from the neck plate. blood circulation to the
skin under the tape, and
result in the discomfort
for the patient.
Place around back of client’s neck and
repeat above step with other end of tie.
Apply tracheostomy dressing
Position client for comfort.

Discard materials and wash hands.
Raise side rails and leave call light within
reach to facilitate client safety and permits
communication.
Document procedure’s Report changes in
performance, observations of stoma appearance or
stoma (irritation, redness, edema, secretions
subcutaneous air) and character of
secretions (color, purulence).
Cleaning of the fresh stoma should The area must be

be performed every 8 hours or kept clean and dry to
more frequently if indicated by prevent infection or
accumulation of secretions. irritation of tissues
Ties should be changed every 24
hours or more frequently if soiled
or wet
Unexpected Situations and
Associated Interventions
• Should the tube be coughed
out, the opening may close
and the patient will be
unable to breathe.
• Therefore, a curved
hemostat is always kept at
bedside to maintain an open
airway while signaling for
assistance.
• The hemostat will open
the airway and allow
ventilation in the
spontaneously breathing
patient.
• Spare tracheostomy and
obturator should be kept
at bedside.
Removing soiled dressing.
Preparing sterile field.
Removing oxygen source if one is present.
Rotating inner cannula while stabilizing outer cannula.
Removing inner cannula for cleaning .
Removing contaminate gloves.
Using brush to clean inner cannula.
Rinsing cannula using an agitating motion
Tapping cannula to remove excessive moisture
Replacing inner cannula.
Reapplying oxygen source
Releasing lock on inner cannula.
Cleaning with cotton-tipped
applicators under faceplate
Putting skin around stoma gently.
Sliding new tracheostomy dressing under faceplate.
Cutting twill tape
Pulling tape through along side old tape
Tying ends with a double square knot
Removing old ties.
References
1. Skills Laboratory Manual, Lorma Colleges

2. http://www.upmc.com/HealthAtoZ/patiente
ducation/Documents/TracheostomyCare.pdf

2021 - 2022 Tracheostomy Care Procedure

Uploaded by

Copyright:

Available Formats

2021 - 2022 Tracheostomy Care Procedure

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2021 - 2022 Tracheostomy Care Procedure

Uploaded by

Copyright:

Available Formats

An Artificial Respiratory

• It is one of the oldest described surgical

• General anesthesia is used. The neck is

• An inherited abnormality of the larynx or trachea

Assess condition of  Evaluate to determine if the

Assess condition or  Assess for redness, swelling, and

Wash hands to reduce

Place all the equipment on  Do not use solutions or

Pick-up one sterile gauze with

Remove tracheostomy  To remove possible

Clean inner cannula by  Gauze can be

Slide inner cannula into outer cannula using

Position client for comfort.

Cleaning of the fresh stoma should The area must be

1. Skills Laboratory Manual, Lorma Colleges

You might also like