TRACHEOSTOMY AND ITS

CARE

NURSING EDUCATOR
TRACHEOSTOMY
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 INDICATIONS OF TRACHEOSTOMY
•   Prolonged mechanical ventilation.
• Upper airway obstruction
• Difficult airway
• Copious secretions
• Congenital anomaly (eg, laryngeal hypoplasia, vascular
web)
• Supraglottic or glottic pathologic condition
•
•
 PURPOSES OF TRACHEOSTOMY CARE
• TO MAINTAIN AIRWAY PATENCY
• TO PREVENT INFECTION AT THE TRACHEOSTOMY
SITE
• TO FACILITATE HEALING AND PREVENT SKIN
EXCORIATION AROUND TRACHEOSTOMY CARE.
• TO PROMOTE COMFORT
• TO ASSESS THE CONDITION OF OSTOMY.
• CARE OF TRACHEOSTOMY
• FRESH TRACHEOSTOMY DRESSING SHOULD BE
KEPT IN PLACE FOR 1 DAY UNLESS INDICATED
OTHERWISE
• FROM DAY 2 ONWARDS DRESSING SHOULD BE
CHANGED DAILY OR WHENEVER NECESSARY
• CARE TO BE TAKEN TO AVOID TUBE
DISPLACEMENT OR DISLODGEMENT.
• USE 0.9% NS TO CLEAN STOMA
• NO CREAM OR OINTMENT AROUND THE STOMA SITE
• DO NOT USE ANY POWDER
• TRACHEOSTOMY TIES SHOULD BE REPLACED DAILY BUT
ALWAYS CONSIDER REPLACING WHEN LOOKS DIRTY, WET,
TOO LOOSE OR TIGHT
CUFF PRESSURE

• CUFF PRESSURE SHOULD BE MEASURED IN EVERY SHIFT

• MAINTAIN BETWEEN 15-30 CM H2O
• HIGHER PRESSURE CAUSE MUCOSAL DAMAGE
• LOW PRESSURE MAY CAUSE ASPIRATION AND
HYPOVENTILATION AND TUBE DISLOCATION.
 DOCUMENTATION
• DATE AND TIME OF TRACHEOSTOMY
• PRESENCE OF SECRETIONS AND ITS CHARACTER
• CONDITION OF WOUND
• ANY DISCHARGE
• TIME OF CHANGE OF INNER CANNULA(IF ANY)
• TEACHING TO THE FAMILY MEMBERS. (USE
WARM BOILED WATER TO CLEAN
TRACHEOSTOMIES WHICH ARE >3 DAYS OLD).
 HUMIDIFICATION
*USE OF HME
INDICATIONS
*NEW TRACHEOSTOMY TUBE
*DEHYDRATION
*IMMOBILITY
*PROLONGED MECHANICAL VENTILATION
*HYPOTHERMIA
 TRACHEOSTOMY SUCTION
Before proceeding suction always assess for :
❖Oxygen management
❖Use of correct suction pressure
❖Liquefying secretions
❖Using the proper size suction catheter and insertion
distance
❖Appropriate patient positioning
❖Keep emergency equipment nearby
 WHEN TO APPLY SUNCTION

• Suctioning should be done usually in the morning

• Once at night and after any respiratory
intervention/physiotherapy
• Patient not able to clear copious secreations and having
difficulty in breathing due to suspected secreations
 TECHNIQUES OF SUCTIONING
• Provide semi fowlers position, administer 100% oxygen
for 2mts before suctioning
• If patient is breathing spontaneously, ask him/her to take
2-3 breaths with ambu bag
• Proper sized suction catheter
• DO NOT USE PRESSURE >120 MM hg for open
system and 160 mm hg for closed system suctioning
• Apply suction only when withdrawing the suction
catheter
❖Limit the suction period to 5-10 sec and maximum 3
passes of suction catheter
❖To pass the suction catheter 0.5 – 1cm of the tube for an
open and 1-2cm
❖Discontinue suction ing if HR reduced by 20 beats/mt or
increased by 40beats/mt, induce arrythmia or reduction in
spo2 below 90%
❖Suction catheter should be discarded after every suction.
 CARE OF INNER CANNULA
• If present should be inspected and whenever needed
cleaned in every shift or more frequently in order to
prevent tube blockage.
• Sterile 0.9% NS should be used to clean the inner
canula
• Used tube should be rinsed with sterile 0.9% NS and
allow it to become dry before inserting again
 ORAL FEEDING WITH TRACHEOSTOMY
• Semi sitting/sitting position while eating
• Give in small bites, usually with teaspoon(<5ml at a time)
• Allow to chew completely and swallow food before
another bite
• Initially feeding training should be provided
• If patient having cuffed tracheostomy, the cuff should be
deflated. It will make swallowing much easier and
comfortable.
• Suctioning of tracheostomy tube should be done
prior to oral feeding because suction through the
tracheostomy tube after feeding may stimulate
vomiting
• Always observe the patient while eating, to be sure
food does not get into the trachea