TRACHEOSTOMY

BY
MUNJILI B. MR.

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 ANATOMY OF THE TRACHEA
• The trachea is a continuation of the larynx and
extends downwards to about the level of the 5th
thoracic vertebra where it divides (bifurcates) at the
carina into the right and left bronchi,one bronchus
going to each lung.
• The trachea is composed of from 16-20 incomplete
(c-shaped) rings of hyaline cartilages situated one
above the other.

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 DEFINATION OF TERMS
1. TRACHEOTOMY; This is a surgical incision into the
trachea for the purpose of establishing an airway.
2. TRACHEOSTOMY;This is the stoma that results
from the tracheotomy, and its when an indwelling
tube is inserted into the trachea
3. TRACHEOSTOMY;This is an artificial respiratory
opening made in the anterior wall of the neck and
trachea-made between the 2nd and 3rd or 3rd and
4th tracheal rings.
4. TRACHEOSTOMY;Is the creation of an artificial
opening into the trachea through which breathing
occurs.

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 TYPES OF TRACHEOSTOMY
1. EMMERGENCY TRACHEOSTOMY;This is when an
operation is done immediately e.g. in foreign
bodies.
2. ELECTIVE TRACHEOSTOMY;This is when the
patient is prepared in advance e.g. in cancer of
the upper respiratory tract.
3. TEMPORAL TRACHEOSTOMY;This is a
tracheotomy which is performed for a short
period then closed.
4. PERMANENT TRACHEOSTOMY;This is left for a life
time.

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 INDICATIONS FOR A TRACHEOSTOMY.
• INDICATIONS

• Obstructive Condition of the Larynx.

– Acute Oedema of the epiglottis
– Carcinoma of the Larynx
– Impacted foreign bodies
– Trauma
– Burns of the mouth or Larynx
– Acute Laryngitis particularly Diphtheric membrane
•

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 Indications Cont’d
• B) Paralysis or Spasms of the respiratory
muscles and Respiratory failure
• 1) Bulbar paralysis
• 2) Tetanus
• 3) certain stages of coma.

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 POST OPERATIVECARE
Environment
• Pt Nursed in acute bay for the first 48 hours.
• Clean environment , free of dust to prevent infection and
irritation of the patients airway.
• Humidified oxygen should be available within the patients
surrounding in case of respiratory distress.
• Suctioning apparatus are required to clear air way.
• Bell near the patient or buzzer as a means of
communication to alert the nurses or caregivers in case of
assistance.
• The environment should have enough light for easy
observation.
• Positioning and maintenance of a patent airway
• Patient nursed in lateral or lying position to
promote draining of secretions.
• The patient take slow deep breath , turning and
coughing to assist in mobilizing secretions.
• The tube will be observed for any accumulation
of excess secretions suctioning will be done
whenever necessary.
• Observations
• Monitoring of the patients level of at least
quarter hourly after the patient gets back
from theatre
• vital signs will be done quarter hourly.
• close monitoring of the stoma site for redness,
swelling, and bleeding as these are common
signs of inflammation and will help take
appropriate intervention.
 Observations cont’d
• Oxygen saturation will be monitored with an
oxymetry to rule out hypoxia.
• vital sign will be done temperature to rule out
infection, blood pressure to rule out hypotension
which may be due to excessive bleeding during
the procedure.
• The air way will be observed and if any
obstruction or secretions mild suctioning will be
done to promote proper breathing. Observe if
the tube is in situ to prevent dislodging
• Pain movement
• Patient may be positioned in the most
comfortable position minding the stoma site
to prevent injury and promote comfort. Give
divisional therapy such as television to shift
his mind off the pain. Prescibed analgesics can
be given such as pethidine 50-100mg
whenever necessary or as prescribed but
being conscious with addiction
• Psychological care
• Re assure the patient as this state is very frightening
experience
• Explain to family and patient that there will be temporal
loss of voice due to the tracheostomy so as to allay anxiety.
Allow family and patient to ask questions so as to allay
anxiety and gain knowledge about the condition
• . An individual who had undergone the same procedure will
be invited to allay anxiety to the relatives and patient to
help patient gain hope.
• Family and patient will be explained to on the means of
communication.
 Rest and exercise

• Encourage the patient to have enough rest so as

to prevent respiratory distress because of the
operation done.
• A quiet environment, clean and comfortable will
promote rest.
• Unnecessary suctioning will be avoided to avoid
disturbing the patient. Minimal neck exercises
will be allowed or done to prevent neck stiffness.
• Mobility of the patient at least third day post
operatively will be allowed to avoid muscle
contractures and pressure sores.
 Nutrition

• Insertion of the nasal gastric tube will be done

to use for feeding and ensure adequate
nutrition.
• Liquids are encouraged as soon as there is no
danger of vomiting. Proceed with semi solid
foods and then solids,
• Reporting of any leakage of fluids if any at
once. A fluid balance chart is necessary to
monitor the fluid balance
 Wound care or stoma care

• The dressing that is the first dressing will be removed by

the surgeon and cleaned with normal saline and sterile
cotton swabs to prevent infection
• . Frequent wound cleaning will be done at least two
times to promote wound healing and prevent infection.
• Wound care or stoma care will be done with a sterile
pack of wound dressing to promote sterility and prevent
infection.
• The gauze will be changed and secure with tapes.
Whenever necessary or soiled to prevent infection and
promote self-esteem.
 Hygiene

• The patient will be assisted with activities of

daily living to promote quick healing.
• Bed bathing will be done a few days after an
operation and assisted bath will be done
when patient becomes mobile so as to
promote good hygiene.
• Proper oral toilet will be done to prevent
halitosis.
 Speech therapy

• The patient will be closer to the nurses bay or

station and the central call light system will be
marked to indicate that the client cannot speak.
• The and family will be taught about
communication skills that is use of pictures and
letters, hand signals or a computer as well as a
call light within the reach of the patient to
promote communication and decrease
frustration or irritability.
 Speech therapy cont’d
• Questions will not be open ended as they may
need explanation hence they will be ‘yes’ or ‘no’
answers for efficient response.
• A bell will be placed at the patients reach so as to
call the nurse to facilitate communication.
• A cuff less tube with a covered, fenestrated
tracheostomy tube in place will be used to
enable the patient speak.
• When the patient can tolerate cuff deflation, he
or she places a finger over the tracheostomy tube
on exhalation to allow speech.
• Elimination
• Constipation will be a problem initially but
introduction of fiber containing foods will help
relief constipation. Enough fluids will promote
use of a urinary catheter for excretion of urine
and bed pan for bowel opening
 Information, education and
communication
• . Instructions are given concerning care of the wound and stoma
especially if permanent to promote hygiene and prevent infection.
• Patient will be advised not to swim and to be careful when bathing
that is covering the stoma to avoid water from entering and causing
chocking in the airway.
• When taking walks, they need to wear a scuff or collared shirt to
cover the opening and the shirt should be porous to promote
proper air circulation.
• Advise on drug adherence will be given to promote healing.
• proper nutrition will be emphasized to provide energy, rebuild
worn out tissue, to boost the immunity.
• Patient and relatives will be advised to maintain good hygiene to
prevent infection.
NURSING PROBLEMS /DIAGNOSES
• 1. Risk of Airway Obstruction related to
Secretions and Swelling (blocked cannula)
• 2. Risk of the Tracheostomy Tube Dislodging
and Cross – Infection
• 3. Pain related to nerve injury caused by
surgical incision
• 4. Risk of bleeding related to Surgery in the
highly vascular area.

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 COMPLICATIONS OF TRACHEOSTOMY
1. Hemorrhage which could be primary or secondary because
the tracheotomy area is very vascular.
2. Surgical emphysema( presence of air in the subcutaneous
tissue) due to excessive dissection of tissue.
3. Pneumothorax common in children due an injury of the
epiod pleural.
4. Displacement of the tube due to improper fitting of
tracheotomy tubes.
5. Blockage of the tracheotomy tube leading to asphyxia.
6. Atelectasis
7. Trachea ulceration and stenosis.
8. Difficult in decannulation.

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