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Tracheostomy Care Guidelines

Tracheostomy Care Guidelines

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Published by cpradheep
Tracheostomy Care Guidelines
Tracheostomy Care Guidelines

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Published by: cpradheep on Feb 03, 2010
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03/29/2013

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Tracheostomy care guidelines
St. James’s Hospital / Royal Victoria Eye and Ear Hospital
Tracheostomy Care Working Group
October 2000
These guidelines have been produced as an educational support and guide for healthcare professionals caring for tracheostomy patients in the clinical setting. Advice onthe care of a specific patient should always be sought from a suitably qualified professional.The guidelines have been ratified by the Head and Neck Nurses Association of Ireland (HANNA) and are recommended for use by its members.
GUIDELINES WRITTEN BY:
 
TRACHEOSTOMY CARE WORKING GROUP of ST. JAMES’S / ROYAL VICTORIA EYE AND EAR HOSPITALS
Ms. Margaret Codd, RGN, BNS (St. James’s Hospital) - ChairpersonMs. Yvonne Sheridan, RGN (St. James’s Hospital)Ms. Hilary Collins, RGN (St. James’s Hospital)Ms. Janine Ryan, RGN (St. James’s Hospital)Ms. Maria Creggy, RGN (St. James’s Hospital)Ms. Michelle Royale, RGN (St. James’s Hospital)Ms. Kathleen Canavan, RN, BNS (St. James’s Hospital)Ms. Mildred Grubb, RN, RM, Dip.Nsg.Ed.,Dip.Med.Ed., M.Med. Ed (St. James’s Hospital)Ms. Caroline Murphy RGN (Royal Victoria Eye and Ear Hospital)
GUIDELINES REVIEWED BY:
Prof. C. Timon, Consultant Otolaryngologist, (SJH / RVEEH)Ms. D. Hyland, Acting Nurse Manager, St. John’s Ward,(St. James’s Hospital)Mr. C. Huet, Nurse Tutor, (RVEEH)Mr. C. Beirne Consultant Maxillofacial Surgeon, (St. James’s Hospital)Dr. J. Moriarty, Consultant Anaesthetist, (St. James’s Hospital)Dr. F. O’ Connell, Consultant Physician, (St. James’s Hospital)Ms. A. O’Brien, Infection Control Sister, (St. James’s Hospital)Ms. O.J. Power, Clinical Facilitator, ICU, (St. James’s Hospital)Ms. S. James, Senior Speech and Language Therapist, (St. James’s Hospital)Ms. S. Brady, Senior Clinical Nutritionist, (St. James’s Hospital)Ms. A. M. O’Grady, Senior Physiotherapist, (St. James’s Hospital)
 
 
GUIDELINES INCLUDED
Overview of tracheostomies
Bedside equipment.
Care of the inner cannula, stoma site and tracheostomy ties.
Suctioning via a tracheostomy tube.
Humidification of inspired gases.
Care of cuffed tracheostomy tube
Care of fenestrated tracheostomy tube
Care of Passy Muir speaking valves.
Decannulation: removal of tracheostomy tube.
Dealing with emergencies.
Resuscitation via a tracheostomy tube.
 
 
OVERVIEW OF TRACHEOSTOMY TUBES
DEFINITIONS
 
INDICATIONS FOR TRACHEOSTOMY
 
TRACHEOTOMY
:
 
Incision made below thecricoid cartilage through the 2
nd
-4
th
tracheal rings
TRACHEOSTOMY:
 
The opening or stoma made by this incision.
TRACHEOSTOMY TUBE:
Artificial airwayinserted into the trachea duringtracheotomy
Bypass acute upper airway obstruction.
Chronic upper airway obstruction.
Facilitate weaning from mechanicalventilation by decreasing anatomicaldeadspace.
Prevention / treatment of retainedtracheobronchial secretions.
Prevention of pulmonary aspiration.
Figure 1. TRACHEOSTOMY TUBE IN SITU
 
Figure 2. TRACHEOSTOMY TUBE COMPONANTS
 
COMPONANTS OF TRACHEOSTOMY TUBE
(See Figure 2)1.
Outer tube
2.
Inner tube:
Fits snugly into outer tube, can be easily removed for cleaning.3.
Flange:
Flat plastic plate attached to outer tube - lies flush against the patient’sneck.
 
4.
15mm outer diameter termination:
Fits all ventilator and respiratory equipment.
All remaining features are optional
5.
Cuff:
Inflatable air reservoir (high volume, low pressure) - helps anchor thetracheostomy tube in place and provides maximum airway sealing with theleast amount of local compression. To inflate, air is injected via the...6.
Air inlet valve:
One way valve that prevents spontaneous escape of the injected air.7.
Air inlet line:
Route for air from air inlet valve to cuff.8.
Pilot cuff:
Serves as an indicator of the amount of air in the cuff 9.
Fenestration:
Hole situated on the curve of the outer tube - used to enhance airflow inand out of the trachea. Single or multiple fenestrations are available.10.
Speaking valve / tracheostomy button or cap
: Used to occlude the tracheostomy tubeopening (a) former - during expiration to facilitate speech and swallow,(b) latter - during both inspiration and expiration prior to decannulation.

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