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Tracheostomy Care Skills

Tracheostomy Care Skills

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Published by hoangt2002

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Published by: hoangt2002 on Oct 10, 2009
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02/03/2015

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 Tracheostomy Care Skills
During the skill
Promote patient involvement as possible.
Assess patient’s tolerance, being alert for signs and symptoms of discomfort and fatigue
Completion of procedure
Assist the patient to a position of comfort and place needed itemswithin easy reach. Be certain patient has a means to call forassistance
Remove gloves and all protective barriers. Store or remove anddispose of soiled supplies and equipment according to agency policyand guidelines form CDC and osha
Wash hands after patient contact and after removing gloves.
Document patient’s response, expected or unexpected outcomes, ,andpatient teaching.
Report any unexpected outcomes
Oxygen therapy
Goal of oxygen therapy is to prevent or relieve hypoxia
If combined with other factor, suh as an electrical spark or fire, it willsupport combustion and ignite.
Oxygen therapy is frequently initiated by respiratory therapist, who isa health care professional licensed to deliver Tx that will improve apatient’s ventilation and oxygenation needs.
 The signs and symptoms manifested by patients who might requireoxygen will vary according to the degree of oxygen deficiency.
Can not delegate oxygen therapy to assistant personnel
 Transtracheal oxygen delivery
A newer method of oxygen therapy
2
nd
and 3
rd
tracheal cartilage
Care of the tracheostomy
Artificial opening made by a surgical incision into the trachea
Provide pt. /c a patent airway
 The physician insert is a tracheostomy tube and secures it inplace with cotton tape
Could be permanent or temporary
It is essential that nursing intervention be consistent
 T piece tube
Require constant humidification to the airway
 The t-pice is a t shaped deei with a 15mm connection withlarge-lumen tubing
 Tracheostomy
Care of a tracheostomy
 
Performed to provide the patient airway patent
 The primary nursing respon. Tis
to maintain patent airway
Keep the inner cannula clean
Prevent impairment of surrounding tissue
Provide a means of communication for the patient
Steps to trach suctionging and cleaning
Assemble equipment
Assess tracheostomy for exudates, edema and respiratoryobstruction
Position in semi-fowler position
 This allows for optimum lung expansion
Provide paper and pencil for patient (This allowspatient to communicate because patient cannotspeak)
Position self at head of bed
Always face the patient while cleaning atracheostomy
 This enables you to access respiratorydifficulty and coughing, which expel cannula
Auscultate lungs – this provides a baselineassessment
Place towel or prepackaged drape undertracheostomy and across the chest this protectsgown and bed linens
Prepare equipment
 This organizes procedure
Open suction catheter leaving it in its wrapper andattach it to the suction machine
 This maintains sterility
Pour cleansing sol’n in one basin and risinsing sol’nin another (w/ ungloved hnd if prepackaged basins)
 The first basin should hold hydrogen peroxide
 This cleanses mucus and secretions frominner cannula
 Turn on suction machine
Apply other sterile glove.Keep dominant handsterile.
Unlock and remove inner cannular place inhydrogen peroxide clensing solution
Place fingers on tabs of outer cannula
 This prevents movement that may irritatesurrounding tissue and cause pain and coughing.
 
Suction inner portion of outer cannula
Prior to suctioning the iner cannula moisten thecatheter tip /c sterile saline rinsing solution
Preoxygenate the patient
Remove thumb from suction control
 This prevents suctioning while insertingcatheter which could damage the mucosa
Insert catheter into trach tube using sterile glovedhand
Insert catheter 5 – 6 inches
 The depth catheter should be the length of outercannula and extend 1 to 2 inches beyond distalend.
Apply intermittent suction by placing thumb on andoff suction control and gently rotate catheter as itis withdrawn
Suction for a maximum of 10 seconds NO LONGER
Prolonged suctioning depletes oxygen supply
Allow patient to rest between suctioningoxygenate them if previously receivingoxygen
Rinse with sterile saline solution and repeat
 Turn off suction and dispose of catheter
Apply second sterile glove if one-glovetechnique was used or a new pair of sterilegloves
 This reduces spread of microorganisms
Insert inner cannula and click in place
 This secures inner cannula and reestablishesoxygen supply
Clean skin around tracheostomy and tbs of outer cannula with hydrogen peroxide andcotton tipped swabs.
Change cotton tapes
Obtain assistance of another personwho will stabilize the tracheostomytube while one set of ties is removedand replaced.
Do this last
Bing clean tape under back of neck

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