Tracheostomy is a surgical opening in the trachea

(windpipe) to make breathing easier

Opening is called a Stoma
Indications:
Mechanical ventilation
Failed endotracheal intubation
Large tumor of the head and neck
Types of Tracheostomy Tube
UNCUFFED- may be plastic or metal, which allows for air
to flow around the tube ( permanent tracheostomy)

CUFFED-are surrounded by an inflatable cuff that

produces an airtight seal between the tube and the
trachea.Often used immediately after a tracheostomy and
are essential when ventilating a tracheostomy client with a
mechanical ventilator.

FENESTRATED-has holes in the outer cannula. Is is used

when the client is being weaned (gradual discontinuation
of mechanical support)
Parts of a Tracheostomy Tube
Tube with inner Cannula
PARTS OF TRACHEOSTOMY TUBE:

OUTER CANNULA – that is inserted to the trachea

INNER CANNULA – may be removed for periodic cleaning
NECK PLATE ( FLANGE) – rests against the neck and allows the
tube to be secured in place with tape or ties
OBTURATOR – used to insert the outer cannula and then
removed; it is kept at the client’s bedside in case the tube
becomes dislodged and needs to be reinserted
CUFF – produces an airtight seal between the tube and the
trachea. This seal prevents aspiration of oropharyngeal
secretions and air leakage between the tube and the trachea
FENESTRATION- hole in the outer cannula
Tracheostomy Ties
Types: twill, Velcro, metal bead
 ADVANTAGES:

1.) maintains airway patency

2.) maintains cleanliness and prevents infection at the tracheostomy
site
3.) facilitates healing and prevents skin excoriation around the
tracheostomy incision
4.) promotes comfort
DISADVANTAGE:
- air is no longer filtered and humidified; special precautions are
necessary
Solution:
-wear a light scarf or 4x4 inch gauze held in place with a cotton twill
ties over the stoma to filter the air
Nursing Responsibilities:
Provide tracheostomy care at least every 8 hrs after the initial
inflammatory response
Hyperoxygenate the client and perform suctioning to remove
secretions from the lumen of the tube (10-15 secs.)( total time –
5 mins.)
If an inner cannula is present, remove and clean and replace
with a new one
Sterile technique must be observed all through out the
procedure
Asesssment of the peristomal skin and incision site must be
done and notify the Physician for any abnormalities.
 Suctioning
When: Suction as necessary
Maintain a patent airway and prevent airway
obstruction
Promote respiratory function (optimal exchange of
O2 and CO2 into and out of the lungs)
 Prevent pneumonia that may result from
accumulated secretions
Complications:
hypoxemia, trauma to airway, cardiac dysrhythmia
related to hypoxemia
Suctioning stimulates cough reflex and stimulates
mucus production
IT SHOULD ONLY BE DONE WHEN BREATH
SOUNDS INICATE THAT THE NEED IS PRESENT!
The diameter of the suction catheter should be
about half the inside diameter of the tracheostomy
tube to prevent hypoxia
Materials:
- Resuscitation bag (Ambu bag) connected to 100%
Oxygen)
- Sterile towel
- Suction machine
- Suction catheter
- Sterile Gloves
- Sterile Water for flushing
- Goggles/ Gown if necessary
- Moisture-resistant bag
Steps:
Asses the need for suctioning.
Greet the patient, explain the procedure.
Place the patient in Semi-fowler’s position to
promote breathing, maximum lung expansion,
and productive coughing.
Prepare the equipments.

Attach the resuscitation apparatus to the

oxygen source.
Open the sterile supplies in readiness for use
Put on sterile glove
Place sterile towel across the patient’s chest.
Hyperoxigenate the patient before, during and
after the procedure.
Flush and lubricate the Suction catheter.
Press the Ambu Bag 3-5 times as the client inhales.
Quickly but gently insert the catheter (6 in.,
without applying suction) until the client coughs
or if you feel resistance.
If resistance is felt, withdraw the tube for about 1-2
cm before applying suction.
Perform suctioning.
Apply intermittent suction about 5-10 sec.
Rotate the catheter while withdrawing to prevent
tissue trauma.
Hyperventilate the patient.
If the secretion is thick, flush the catheter.
Reassess the patient’s oxygenation status and
repeat suctioning as needed.
Allow 2-3 minutes between suction as possible to
provide the opportunity for reoxygenation of the
lungs.
Repeat until the air passage is clear and the
breathing is effortless and quiet.
After each suction, ventilate the patient with 5
breaths.
Dispose equipments
Provide client’s comfort and safety
Document.
Cleaning a Double-Cannula Tube/ Changing a
Tracheostomy dressing and ties

When: dressing is soiled- harbors microorganisms

and source of skin breakdown, and infection.
Check order of doctor if there is an order for
antibiotic ointment to the stoma.
When: excessive secretions, soiled tracheostomy
dressing or ties, labored breathing indicating
diminished air flow through trach tube
To maintain cleanliness and prevent infection at
the tracheostomy site.
To maintain airway patency.
To prevent skin breakdown around the stoma.
Steps:
Assess the need for cleaning the stoma.
Greet the patient, explain the procedure.
Prepare the equipments.
Don gloves and suction if indicated.
Remove the soiled dressing using pick up forceps.
Remove the inner cannula (counter clockwise) by
gently pulling it towards you and in line with its
curvature.

Soak the inner cannula in diluted Hydrogen

peroxide to moisten and loosen secretions.
Put oxygen source.
Clean the flange and the stoma using sterile
water/saline. Pat dry.

Change gloves and replace it with sterile gloves.

Remove the cannula from the soaking solution.
Clean the lumen and entire inner cannula
thoroughly.

Agitate in sterile saline.

Inspect the cannula for cleanliness by holding it at
the eye level and looking through it into the light.
After rinsing the cannula, gently tap it against the
inside edge of the sterile solution bowl.
Dry inside of cannula.
Insert the inner cannula and secure it.
Place a sterile dressing.
• To make a tracheostomy dressing from a 4 x 4
gauze, open gauze to an 8” x 4”size, then fold
lengthwise.

• Fold gauze corners up.

• Slide folded gauze under tracheostomy strings.

Change ties.

Document relevant data.