Tracheostomy Care ➔ Maybe soaked with blood and this can be a source of

- Done when there is (-) spontaneous breathing infection.

Tracheotomy
- A surgical procedure in which an opening is
made into the trachea (for airway). The indwelling
tube inserted into the trachea is called
tracheostomy tube.
- Permanent or temporary.
- Priority: Airway, Breathing, Circulation, Vital
Signs
➔ CPR: Circulation, Airway, Breathing
Tracheostomy tube
Parts:
o Outer cannula – in contact with the nurse
o Inner cannula – where airway exchange occurs,
cleaned, and returned to the patient
o Obturator
o Plug – cannulation
o Cuff – balloon inside which is being inflated, prevents
any aspiration by blocking the entrance of mucus and
other secretions that obstructs the airway
Procedure:
1. Performed in the operating room (ideal) or in an
intensive care unit (emergency cases).
➔ Ideally uses general anesthesia, in emergency cases,
doctor may not prescribe anesthesia before the
procedure.
2. Opening is made in the 2nd and 3rd tracheal ring
(depends on the doctor).
3. The tracheostomy tube is held in place by tapes or
“tie” fastened around the client’s neck.
➔ Performed with doctor’s order.
Complications:
A. Acute: IMMEDIATE PROBLEMS
a) Bleeding – occurs upon making an opening in the
trachea
• Assess nape area
• Bright red in color
• Repeated usage of gauze pad also indicates
bleeding
b) Aspiration – top priority
c) Laryngeal nerve damage
• Larynx is very proximal to the trachea
• Upon opening the trachea, laryngeal nerve can
be affected
• Sign: Voice hoarseness (dysphonia)
• To Assess: Ask the client to speak
B. Chronic: LONG TERM PROBLEMS (may appear
upon discharge of the patient)
a) Tracheal ischemia and necrosis
• Brown and Black skin discoloration – tissue
necrosis
b) Infection – temperature and heart rate of the
patient increases
• Check WBC: (N: 5,000-10,000)
• Infection s/sx: WBC > 10,000, Fever,
Erythema (reddish discoloration of the skin)
• Risk for infection: WBC < 5,000
➔ Avoid giving fresh food
Post-op Care:
1. Keep patent airway.
✓ Check O2 Sat: (N: > 95%)
2. Keep tracheotomy tube at bedside (for easier
replacement during an emergency).
3. Semi-fowlers (30-45 degrees) to facilitate ventilation
and promote drainage.
4. Keep paper and pencil or a magic slate and the call
light within the patient’s reach (for easier
communication).
Tracheostomy Care
• Suction as needed
❖ Frequency: PRN to avoid hypoxia
❖ Position: Semi-fowlers
❖ Lubricate the catheter
❖ Hyperventilate the patient
➔ Rationale: To increase O2 and decrease the risk of ❖ 4-5 fingers: Loose
hypoxia • Decannulation (removal of tracheostomy tube) when
❖ Apply suction on withdrawal (approx 110 mmHg) the indication does not longer exist.
❖ Duration: 10 sex approx. Board Exam Questions:
❖ Interval: 20-30 secs (buy time before inserting 1. Which of the following measure should the nurse
to remove secretions) perform in relation to suctioning a tube?
• Maintain skin integrity. Ans: Administer O2 before suctioning the client.
❖ (+) Trauma 2. To more easily remove the tenacious secretions
❖ Increase OFI when suctioning a tracheostomy, the nurse should
❖ Use inspection skills liquify the secretions using?
• Change tape and dressing. Ans: Diluted hydrogen peroxide
❖ Frequency: Daily or as needed 3. Complications associated with tracheostomy include:
• Auscultate lung sound and monitor cyanosis Ans: Damage to the laryngeal nerve
❖ Normal lung sound: clear
❖ Skin assessment
• Monitor infection
❖ Check WBC, Temp, HR, RR
❖ HR: Compensatory mechanism with failing RR
(Normal HR: 60-100 bpm)
❖ RR: (Normal: 12-20 cpm or 14-20 cpm)
• Maintain oxygenation (humidified) and hydration.
❖ Hydration: To loosen secretions.
❖ Check the weight of the patient (Compare weight
before and during admission)
❖ Oxygenation: Use the pulse oximeter (Normal:
> 95%)
❖ Reportable 02 Sat: < 88% (Hypoxia)
• Use sterile technique when suctioning and performing
tracheostomy care.
❖ Home care: Medical asepsis
❖ Hospital care: Surgical asepsis
❖ Use gloves all the time -> Risk for infection
(Pneumonia)
• Clean using hydrogen peroxide, sterile water, and
cotton-tipped applicators.
❖ Hydrogen peroxide should be mixed with sterile
water to loosen secretions.
❖ Cotton tip applicators: Removes tenacious
secretions
• Use gloves when cleaning the wound.
• Remove soiled tape after the new clean tape is in
place.
❖ Before removing the old tape, place the new
tape to avoid airway dislodgement and
dislocation of tracheostomy tube.
• Only 2 fingers can be comfortably inserted in it.
❖ 1 finger: Too tight