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 items
within easy reach. Be certain patient has a means to call for
assistance
○ Remove gloves and all protective barriers. Store or remove and
dispose of soiled supplies and equipment according to agency policy
and guidelines form CDC and osha
○ Wash hands after patient contact and after removing gloves.
○ Document patient’s response, expected or unexpected outcomes, ,and
patient 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 will
support combustion and ignite.
○ Oxygen therapy is frequently initiated by respiratory therapist, who is
a health care professional licensed to deliver Tx that will improve a
patient’s ventilation and oxygenation needs.
○ The signs and symptoms manifested by patients who might require
oxygen 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
○ 2nd and 3rd 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 in
place 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 with
large-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 respiratory
obstruction
• Position in semi-fowler position
○ This allows for optimum lung expansion
○ Provide paper and pencil for patient (This allows
patient to communicate because patient cannot
speak)
• Position self at head of bed
○ Always face the patient while cleaning a
tracheostomy
 This enables you to access respiratory
difficulty and coughing, which expel cannula
○ Auscultate lungs – this provides a baseline
assessment
○ Place towel or prepackaged drape under
tracheostomy and across the chest this protects
gown and bed linens
○ Prepare equipment
 This organizes procedure
○ Open suction catheter leaving it in its wrapper and
attach it to the suction machine
 This maintains sterility
○ Pour cleansing sol’n in one basin and risinsing sol’n
in another (w/ ungloved hnd if prepackaged basins)
○ The first basin should hold hydrogen peroxide
 This cleanses mucus and secretions from
inner cannula
○ Turn on suction machine
○ Apply other sterile glove. Keep dominant hand
sterile.
○ Unlock and remove inner cannular place in
hydrogen peroxide clensing solution
○ Place fingers on tabs of outer cannula
○ This prevents movement that may irritate
surrounding tissue and cause pain and coughing.
○ Suction inner portion of outer cannula
○ Prior to suctioning the iner cannula moisten the
catheter tip /c sterile saline rinsing solution
○ Preoxygenate the patient
○ Remove thumb from suction control
 This prevents suctioning while inserting
catheter which could damage the mucosa
○ Insert catheter into trach tube using sterile gloved
hand
○ Insert catheter 5 – 6 inches
○ The depth catheter should be the length of outer
cannula and extend 1 to 2 inches beyond distal
end.
○ Apply intermittent suction by placing thumb on and
off suction control and gently rotate catheter as it
is withdrawn
○ Suction for a maximum of 10 seconds NO LONGER
 Prolonged suctioning depletes oxygen supply
 Allow patient to rest between suctioning
oxygenate them if previously receiving
oxygen
 Rinse with sterile saline solution and repeat
 Turn off suction and dispose of catheter
 Apply second sterile glove if one-glove
technique was used or a new pair of sterile
gloves
• This reduces spread of
microorganisms
○ Insert inner cannula and click in place
 This secures inner cannula and reestablishes
oxygen supply
 Clean skin around tracheostomy and tbs of
outer cannula with hydrogen peroxide and
cotton tipped swabs.
 Change cotton tapes
• Obtain assistance of another person
who will stabilize the tracheostomy
tube while one set of ties is removed
and replaced.
• Do this last
○ Bing clean tape under back of neck
  Hold tracheostomy tube in place to prevent
movement of cannula that could stimulate
coughing and expelling cannula
 Tie ends of two clean cotton tapes together
 Auscultate
○ Reassess pat. Tracheostomy for signs and
symptoms of bleeding, edema, and respiratory
obstruction
 Patient’s with tracheostomy frequently have
bloody secretion
○ Single cannula tracheostomy is used and called a
cuffed tracheostomy tube
 It is made of plastic and has an inflatable cuff
around the middle of the distal portion of the
tube
 The type may be ordered initially until the
healing process is complete
• Care of patient with a cuffed tracheostomy
○ IPPB – intermittent positive
• Endotracheostomy
○ Provide direct route for introduction of pathogens
into the lower airway, increasing the risk for
infection.
○ Can the patient speak if he has a trach tube?
 Endotracheal tubes with uninflated cuffs and
syringe for inflation. Patients are unable to
speak while tube is in place because air
cannot flow through the vocal cords.
 Fenestrated – trach tube with inner cannula
removed
 Trach tube with obturator for insertion and
syringe for inflation of cuff is a piece
• Nursing action
• Gather equip.
• Suction pat.
• Connect
• This provide inflation/deflation of tube balloon
• While listening with stethoscope, slowly inflate cuff with
0.5 to 1 mL of air at a time
• When no air is heard stop withdraw up to 0.5 mL of air
until air leak is auscultated with stethoscope
• If excessive air leak is heard, slowly add 0.5 to 1 mL of air
at a time
 ○ Air leak may prevent lung expansion and increase
○ Sign and symptoms
 Gurgling respirations
 Restlessness
 Vomitus in mouth
 Drooling
○ Explain tha couging, sneezing,a nd gagging is
expected
○ Position patitent – if the patient is conscious
 Place in semi-fowler’s (30-45degree) position
with head to one side
 Placing head to one side promotes drainage
of secretions and helps suction
○ If patient is unconscious
 Place patient in side-lying position facing
 Adults 110-150mm Hg
 Common catheter size : Adults 12-16 French
○ Aspirate solution through cathether by placing
thumb over open end of connector or over vent
○ Insert catheter
○ Oropharyngeal sunctioning
 Gently insert yankauer or tonsillar tip of
suction catheter
• Gentleness prevents tissue trauma
• Glide yankauer toward oropharynx
without suction
• Apply suction and move yankauer tip
around mouth until secretions are
cleared
• Encourage patient to cough
• Rinse yandauer with water in cup or
basin until connector tube is clear of
secretions
• Nasopharyngeal suctioning
○ Turn off suction
○ Nasopharyngeal suctioning
○ Sterile gloves should be worn
○ Holding suction cath with thumb and index finger,
place nasea catheter near patient’s earlobe tip of
nose
 This marks the catheter for correct length
 Length of insertion for adult = 16 cm
 Lubricate with water-soluble jelly
  Hold catheter and gently insert c-into one
side of nasal catheter
 Sterile gloves should be worn
 Hold catheter with thumb and index finger,
place naasotraheal catheter near earlobe to
tip of nose and extend to trachea
 Do not touch side of face, nose or earlobe
maintain sterility
 Length insertion adult =20-44cm
○ Lubricate catheter with a water soluble jelly
○ Ask patient if either side of nose is obstructed use
unobstructed side
○ Stimulate cough reflex or have patient to cough
○ Apply intermittent suction by moving thumb over
opening rotate catheter gently as it is withdrawn.
○ Observe patient closely suction no loner than 10-15
seconds
○ Allow rest periods of 1-2 minutes in between
suctions
○ Place catheter in solution and apply suction
○ Discard catheter
○ Place sterile and unopened catheter at patient’s
bedside
○ Provide mouth care
○ Assess breathing pattern
○ Document

Identify at least four safety precaution for oxygen use in the hospital and home
environment (559)

The patient is to receive oxygen. What assessments should be made by the nurse
(560)

When performing tracheostomy care, the nurse is aware of the following: (565-557)

Cleansing solution to be used

Rinsing solution to be used

The part that is removed for cleaning

Safety measures

What can the nurse do to reduce possible sensory deprivation for the patient with a
tracheostomy? 567-568
What criteria are used for the reinflation of a tracheostomy cuff? (570)

In prepairing to suction a patient, the nursing implements the following (571-573)

Position patient: semi fowler position

Appropriate vacuum pressure for adult patient: 110 to 150 mmHg

Check the patency of suction catheter tubing by placing thumb over open end of
connector or open vent

Lubricant use on tubing with water soluble jelly

Length of insertion for nasotracheal suctioning for adult patient 20 to 24 cm.

Suctioning performed for 10-15 seconds.

Identify at least two signs or symptoms of hypoxia (562)

1. Apprehension, anxiety, restlessness

2. Decreased ability to concentrate

The patient is to receive oxygen via a nasal cannula. The nurse is aware that the
usual flow rate is 2 L/min. Ccomfort measures that should be implemented for this
patient include: proper placement of prongs to prevent oxygen from coming in
direct contact with nasal

Flow rate for the patient who is to receive oxygen via a face mask is 6-10 L/min.

The patient requires suctioning pulmonary secretions. Nursing diagnosis =

ineffective airway clearance

The nursing is working in the special care nursery and will be suctioning the airways
of infants. For this age goup, the pressure of the wall suction should be set at:
(571) 50 to 95 mm Hg

Preparation for tracheostomy care in the acute care environment include: (565-
567)

Preparing cotton swabs with hydrogen peroxide and saline

• Salem Sump – a double-lumen tube: one provides an air vent and the other
is for removal of gastric contents
• Dubhoff -
• Cantor
• Levin – has one lumen and several openings near the tip
• Foley
• Lavacuator
• Sengstaken
 • Blakemore
Know what they are used for.

Of a person has a feeding tube, which for a following type of client?

Person needs more teaching if: Which of the following supplies that the nurse gets
wrong that get the wrong item. ( straw, tapes)

Gastric content the amount should not exceed 120. Know the names of the tube
and what are they used for. Gastric secretion is green.