V What is tracheostomy?

V Indications

V Types of Tracheostomy Tubes

V Tracheostomy Care.

V Weaning from tracheostomy tube

V Suctioning
2 surgical opening into the trachea through which
a tracheostomy tube can be passed to provide
an airway, and to remove secretions from the
lungs. This tube is called a tracheostomy tube
or trach tube.
V iecords indicate that the first tracheostomy was performed 124
years BC by a ioman physician.

V During the Dark 2ges little mention of the operation is recorded, but
it was felt that the cartilages of the trachea would not heal so the
surgical procedure was not commonly performed.

V The tracheostomy tube was first used in the 16th century and by
the 19th century, 28 successful operations had been performed.

V The first tracheostomy tube for children was developed in 1880.

V In 1936 Davidson, an 2merican doctor, advocated the use of this

operation for the respiratory support of polio patients. Today,
tracheostomy is a common procedure and a lifesaver of many
patients who need airway support.
V To bypass an airway obstruction caused by birth defect,
surgery, or trauma.

V To allow for long-term ventilator use.

V Difficulty in weaning the patient from ventilatory support.

V To reduce the risk of laryngeal injury caused by

prolonged translaryngeal intubation and to improve oral
hygiene.

V To access and remove excessive secretions.

2
  



  
2

    

   


 
  


   

2 2

 


  !
 
V Single cannula tracheostomy tube
V Double Cannula Tracheostomy Tube
V Fenestrated Tracheostomy Tube
V Cuffed Tracheostomy Tube
V Un-cuffed Tracheostomy Tube
V Tube Used on all
newborns and most
pediatric patients.

V Has one single

passage used for
both air flow and
suctioning.
V Features a removable
inner cannula that fits
inside an outer
cannula.

V Inner cannula must be

in place to ventilate the
patient

V Outer cannula keeps

the stoma open while
the inner is removed
for cleaning.
V Teaches the patient
to breathe through
the upper airway.

V 2llows for speech.

V Less airway
resistance
V Initial choice

V Used during M.V.

V Decreases the risk of

aspiration.

V Cuffs may be either

foam or balloons.

V Used for adults or

older children.
V Used when M.V. is
not required

V Less airway
resistance compared
to cuffed tube

V Used for Pediatrics.



 "



 



 Wound Care

V Wound Care

V iequires two persons to prevent loss of tracheostomy

V ioutine wound care Ñ risk of infection

V Dialy examination of stoma

V Clean dressing is inserted under the tracheostomy tube

V 
 should be used to reduse the risk of fibers

entering the stoma
V Tracheostomy is held in place with either a
tracheostomy ties or a tracheostomy tube
holder. These ties should be routinely changed
whenever they become wet or soiled. With
infants and active young children, this must be
a two-person procedure, as it is important that
the tube remain stable and not be pulled out.

V When retieing the ties, do not pull them too tight

as you may decrease the blood flow to the
patient¶s head and cause undue pressure to the
skin of the neck.
 Tube Care

V Cleaning double-cannula tracheostomy tube

V Tracheostomy tubes on general medical/surgical

wards should have an inner cannula

‡ Non-disposable inner cannula should be cleaned

daily
‡ Disposable inner cannula should be changed
daily.

V This reduces the risk of tube blockage by

secretions and thus reduces the frequency of tube
changing
 Tube Care
Weaning
Cuff Care

Feeding ( 

Humidification
Speech
Suctionning
Humidification is necessary because the
tracheostomy bypasses the upper airway which
normally moistens the air

The reduction of moisture and heat loss helps to

maintain suitable viscosity of secretions
 Humidification Cont.

Fluid Intake

Patient need adequate amounts of fluid to keep

their mucus loose.

Illnesses associated with fever, diarrhea,

sweating, or vomiting are of special concern.
 Humidification Cont .

Two types of humidifiers for ventilated patients

1) 2ctive: pass inspired gases over heated

water bath

2) Passive: HME (trap humidity from

patients expired gas)
 Humidification Cont.

Frequency of changing HME

(depends on manufacturer¶s recommendations)

‡ Standard: daily

‡ More frequent if occluded by secretions

 Speech

Techniques for promoting speech

in non-ventilated patients

‡ One-way speaking valves

‡ Pneumatic ³talking´ tracheostomy tube
 Nutrition

Complications of Tube Feeding

2spiration

‡ risk 20% - 70%

‡ independent of consciousness level
 Cuff management

‡ iecommended cuff pressure = 20-25mmHg

‡ Low pressure (<18) Ñ Ñaspiration risk

‡ High pressure (>25) Ñ tracheal mucosal damage

 Changing tracheostomy tube
Indications

Non-emergency
‡ routine changing (patients on long-term mechanical
ventilation)
‡ changing tube type (e.g. cuffed to uncuffed)

Emergency
‡ tube blockage
‡ accidental extubation
Changing tracheostomy tube Cont.

V If it is expected to be a difficult change,

consider changing in an operating
theatre/ICU environment.
 Tracheostomy Emergencies

V ›

›
 



  



 




 Weaning from tracheostomy tube
‡ Determining Patient ieadiness

1. 2dequate ventilatory reserve

2. 2dequate nutritional state

3. Patient upper airway

4. 2bsence of serious bronchopulmonary infection

5. 2bsence of impending need for mechanical ventilation

 Determining Patient ieadiness .
Cont

ë




 





  






 




 









 







 
 
V 


V 
 
V  

V !


V


"
 
 
V # 



 $
V %

V



 "

V 
&'

* #(›
)
›

›
* +!›(#


!
+

*

) (

(#(›(


›
!)!
(


#

) › #›(#
!
(
!
!›

%
!
(

)› #›(#
!
# (

* %
,


›(+

›(#
!
+ (#
%
!
(

*
+ !+
›
›
%
›)
+#
*  ,( -

%
 +
›
 

 











!.












$


 
& 

 

ë 


"

















.



 



 


-







 






 



.

! 








 

!

 











 


 
 
 





,









! 
 



* &

›

  








&

 








ë

 









 "

"

 





"

"







-
"



'







/.





"




"
"






 









 




0

 



0






 
 


%



"




(
'&

#





 "

 





%

 








"


 

"


#
 












&
 








 
 
ë



 






 "


!




 "


 #











1



  
  







 





 








 

 
V 












 
V ›
2


 




 




3

 


 






 
V )







 










"


 

V ( 





.


"


 





'






"




V ›








 

 




 











.


 


V   










 

V +


 
V ¢
 * 
 .



"

"



 








 















V

"

"











 



  


&




V  


  




 

 

"




















 

2
V #




. 












 

V








 




















+
"

 















 
 


V 


  







 



  



 

V
V h

* 
.


 

 
 '



V (
 


 








 
V (












"

 




 















›









"


V -






 





1


.














V ,






 

"


"