TRACHEOSTOMY

SUBMITTED TO:

MS. ELSIE DELOS REYES, R.N.

SUBMITTED BY:

ARABIT, MARCELYN O.

EMBERADOR, LAILYN NESS S.

FEBRUARY 09, 2011

Definition

A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe).
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.

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

A tracheostomy may be done if you have:

• 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

Types of Tracheostomy Tubes

A tracheostomy (trach) tube is a curved tube that is inserted into a tracheostomy stoma (the hole made in
the neck and windpipe). There are several different brands of tracheostomy tubes, but all have similar
parts. In double-cannula tubes, the inner cannula is inserted and locked in place after the obturator is
removed; it acts as a removable liner for the more permanent, outer tube. The inner cannula can be
withdrawn for brief periods to be cleaned. The main parts of a double cannula tracheostomy tube are the
outer tube (or cannula), the inner tube (or cannula) and the obturator. The obturator is used only to guide
the outer tube during insertion and is removed immediately after the outer tube is in place. The outer tube
has ties to secure it in place around the child’s neck.

Parts of a Tracheostomy Tube

Single Cannula Silicone Tube

Risks

The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

The risks for any surgery are:

• Bleeding
• Infection

Additional risks include:

• Erosion of the trachea (rare)

• Scar tissue in the trachea
Expectations after surgery

If the tracheostomy is temporary, the tube will eventually be removed. Healing will occur quickly,
leaving a minimal scar. If the tracheostomy tube is permanent, the hole remains open and may require
surgical closure when no longer needed.

Convalescence

Most patients require 1 to 3 days to adapt to breathing through a tracheostomy tube. It will take some time
to learn how to communicate with others. Initially, it may be impossible for the patient to talk or make
sounds.

After training and practice, most patients can learn to talk with a trach tube. Patients or parents learn how
to take care of the tracheostomy during the hospital stay. Home-care service may also be available.

Normal lifestyles are encouraged and most activities can be resumed. When outside, a loose covering (a
scarf or other protection) for the tracheostomy stoma (hole) is recommended. Patients must adhere to
other safety precautions regarding exposure to water, aerosols, powder, or food particles as well.

Normal anatomy

The trachea, or windpipe, carries air from the larynx to the bronchi and lungs.
Indications

The indications for tracheostomy include:

• prolonged intubation during the course of a critical illness

• subglottic stenosis from prior trauma
• obstruction from obesity for sleep apnea
• congenital (inherited) abnormality of the larynx or trachea
• severe neck or mouth injuries
• inhalation of corrosive material smoke or steam
• presence of a large foreign body that occludes the airway
• paralysis of the muscles that affect swallowing causing a danger of aspiration
• long term unconsciousness or coma

Incision

General anesthesia is used and the patient is deep asleep and pain-free. The neck is cleaned and draped.
Incisions are made to expose the tough cartilage rings that make up the outer wall of the trachea.
Procedure

The surgeon then cuts two of these rings and inserts a tracheostomy tube.
Aftercare

Most patients require 1 to 3 days to adapt to breathing through a tracheostomy tube. Communication will
require adjustment. Initially, it may be impossible for the patient to talk or make sounds. After training
and practice, most patients can learn to talk with a trach tube. Patients or parents learn how to take care of
the tracheostomy during the hospital stay. Home-care service may also be available. Normal lifestyles are
encouraged and most activities can be resumed. When outside a loose covering for the tracheostomy
stoma (hole) (a scarf or other protection) is recommended. Other safety precautions regarding exposure to
water, aerosols, powder or food particles must be adhered to.

After treatment of the underlying problem that necessitated the tracheostomy tube initially, the tube is
easily removed, and the hole heals quickly, with only a small scar.
SUCTIONING OF TRACHEOSTOMY

A suction machine has been prescribed by your doctor to help remove secretions and mucus from your
airways. The instructions in this handout will help you and your caregiver correctly perform the suction
procedure and operate the equipment safely.

WHAT IS THE PURPOSE OF TRACHEOSTOMY SUCTIONING?

Tracheostomy suctioning removes thick mucus and secretions from the trachea and lower airway that you
are not able to clear by coughing. Suctioning is done when you wake up in the morning and right before
you go to bed in the evening. Suctioning is also done after any respiratory treatments.

In addition, suctioning may be needed when you:

• Have a moist cough.

• Are unable to effectively clear secretions from the throat.
• Are having difficulty breathing or feel that you can not get enough air.

WHAT SUPPLIES DO I NEED?

You will need the following supplies:

• One gallon of distilled water

• One bottle of hydrogen peroxide
• Small paper cups (4- or 6-ounce size)
• One box of non-sterile gloves
• One bottle of white vinegar
• One box of cotton-tipped swabs
WILL SUCTIONING HURT?

No. Suctioning should not cause pain. You may feel short of breath and you may cough, but these are
normal reactions and should not be painful.

WHERE SHOULD THE SUCTION MACHINE BE USED?

The suction machine should be used in a well-lit area. Place the machine on a sturdy surface that will
support the weight of the suction machine, such as a table or desk.

CARE OF TRACHEOSTOMY EQUIPMENT

• Keep enough supplies available at all times.

• Replace collection canisters, connecting tubing, and suction catheters that are hard or cracked.
• Empty the canister every night or when it becomes half-full.
• Disinfect reusable equipment (the canister, canister lid, and suction tubing).
Every night, soak the equipment for 15 minutes in a basin or sink filled with warm water and
dish detergent.
Every third night, soak the canister, the lid, and the suction tubing for 30 minutes in a solution
of three parts water and one part vinegar.
• Rinse the equipment completely.
• Dry the equipment with clean towels.
• Reassemble the equipment.

TRACHEAL SUCTION GUIDELINES FOR CAREGIVERS

• Gather the following equipment and supplies:

 o Suction machine
o Connecting tubing
o Disinfected suction catheter
o One non-sterile, clean glove
o Distilled water
o Clean, small paper cup
o Clean basin

• Position the patient comfortably with his or her head and neck well-supported.
• Wash your hands with soap and water and dry with a clean towel.
• Fill the small paper cup about half-way with distilled water.
• Place the clean glove on your dominant hand (if you are right-handed, place the glove on your
right hand).
• If the patient has a cuffed tracheostomy tube, check to see if the cuff is properly inflated. (SEE
STEP 6)

• Open the suction catheter package.

• Pick up the hard plastic end of the catheter with your gloved hand and attach it to the connecting
tubing. (Only touch the connecting tubing with your ungloved hand since it is not sterile). ( SEE
STEP 8).
• Wrap the catheter around your gloved hand when not in use to avoid contamination of the
catheter.
• Turn on the suction machine with your ungloved hand.
• Expose the patient's tracheostomy opening.
• With your finger off the suction vent (so that you are NOT applying suction), gently insert the
suction catheter into the tracheostomy opening. Slowly advance the catheter a maximum of 6
inches or until you feel resistance. (SEE STEP 12).
•
•

• Cover the suction vent with the thumb of your ungloved hand to apply suction. (SEE STEP 13).
• Withdraw the catheter and rotate, using a slow and even motion. Roll the catheter between the
thumb and forefinger of your gloved hand. Apply suction as you withdraw the catheter.
• Do not apply suction for longer than 10 seconds.
• Clean the catheter and connecting tubing between each suction pass: dip the catheter into the
small paper cup, place your finger over the suction vent and draw up small amounts of distilled
water through the catheter. Empty the contents of the catheter into the collection basin.
• Allow the patient 20 to 30 seconds to rest between suction passes.
• When the patient's airway is clear and you are finished suctioning, fill a clean basin with distilled
water. Thoroughly flush the distilled water through the catheter and connecting tubing.
• Turn off the suction machine.
• Slide the catheter back into the package and disconnect it from the connecting tubing.
• Hang the connecting tubing on the suction machine with the tip pointing up.
• Rinse the suction catheter and store it with the other equipment to be disinfected.
• Wash the basin with soap and warm water. Dry it with a clean towel and put it away.
• Take off your glove and discard it properly, along with the paper cup.
• Wash your hands with soap and water and dry with a clean towel.