Care during ECT Procedure

Submitted to: Priyanka Madam Submitted by: Ujjwal Sadanshiv

Tracheostomy Care
Tracheostomy Care: 1. Identify parts of a tracheostomy tube & their purposes. 2. Demonstrate safe & effective tracheostomy care. Principles of a Tracheostomy: 1. A patient with a tracheostomy has had a surgically created opening made in the lower airway, usually at the level of the 2nd or 3rd tracheal ring 2. When a tracheostomy is inserted, the upper airway is bypassed- this also includes bypassing the following normal functions humidifying warming filtering of air 3. Mucociliary transport & cough mechanism are impaired with placement of a trach tube 4. Maintenance of airway patency is very important Parts of a Tracheostomy: 1. Outer cannula with cuffs 2. Inner cannula 3. Obturator (toblunt end) 4. Trach tie/ trach collar (oxygen) Tracheostomy Care: Cleaning of the inner cannula is generally performed every 8 hours, & changing the cannula (sterile procedure) every 24-48 hours (or per facility policy) Prior to cleansing the inner cannula, hyperinflate & hyperoxygenate the patient, & suction the airway to remove secretions The area around the trach stoma should be intact/pink, free of irritation, swelling, & purulent drainage Only manufactured drain sponges with slit should only be used around the trach site to avoid lint from entering the stoma Always assess the integrity of the new trach tube & obdurate to be inserted by inflating the cuff to check for a leak Prior to changing the tube, hyperoxygenate the patient & hyperextend the neck The cuff on an artificial airway creates a seal between the wall of the trachea & the outside of the tube, allowing positive pressure ventilation & preventing aspiration of foreign material into the airway & lungs Complications of overinflation of the trach cuff include (due to excess pressure on tracheal wall): Tracheitis Bleeding Tracheal erosion/necrosis Tracheomalacia Tracheal stenosis Tracheoesophageal fistula Tracheoinnominate artery fistula

 Cuff herniation Tracheostomy Care Equipment: Hydrogen peroxide Sterile saline Sterile gloves Disposable tracheostomy kit Clean scissors (if ties must be Replaced) Tracheostomy Care Kit: Sterile gloves Gauze sponges Drain sponge Cotton swabs Pipe cleaners Forceps Trach tie Brush 3 containers Sterile sodium chloride & hydrogen peroxide Tracheostomy Care Procedure: Wash hands Explain procedure Place patient in high fowlers position Open sterile pack Loosen caps on peroxide & saline bottles Remove & discard neck dressing with clean gloves Open sterile gloves Set up sterile field & separate sterile basins Check labels/dates on bottles- if previously used, lip the bottles Place sterile drape over patient Using non-dominant hand (now the clean hand), pour solutions into basins (1 NACL & 1 H2O2/NACL mix) Remove the inner cannula using clean hand & drop into the NaCl/peroxide mix) Dip sterile applicators & gauze in NaCl/peroxide mix, & clean around trach site Next, rinse trach site using sterile applicators & gauze Pick up inner cannula with clean hand on clean end & scrub interior & exterior with brush Rinse inner cannula in NaCl Dry inner cannula with pipe cleaner, leaving small amount of saline on cannula to decrease friction for reinsertion Reinsert cannula with clean hand/lock into place Apply a sterile drain sponge to trach site with forceps or sterile hand Thread clean ties through flange holes & tie securely/carefully cut & remove soiled ties

Tracheostomy Care Documentation: a. Condition of tracheal site b. Size/type of trach c. Patient tolerance- be specific (vital signs, O2 saturation, etc.) d. Color, volume, consistency of sputum e. Improvement in breath sounds