Tracheostomy Care

MEDICAL AND SURGICAL NURSING

TRACHEOSTOMY CARE Lecturer: Mark Fredderick R. Abejo RN,MAN  __________________________________________________

TRACHEOSTOMY

A surgical insicion in the trachea just below the larynx.

A curved tracheostomy tube is inserted to extend through the stoma into the trachea. Clients who need long-term airway support.

Tracheostomy Tube in Place

Lecture Notes on Tracheostomy Care Prepared By: Mark Fredderick R Abejo R.N, M.A.N Clinical Instructor

Tracheostomy tubes have an outer cannula that is inserted into trachea and a flange that rests against the neck and allows the tube to be secured in place with tape or ties.

Obturator is kept at the client’s bedside in case the tubes

Cuffed tracheostomy tubes are surrounded by an inflatable cuff that produce an airtight seal between the tube and the trachea. This seal prevents aspiration of orophrayngeal secretions and air leakage between the tube and the trachea.

Providing Tracheostomy Care Purposes To maintain airway patency To maintain cleanliness and prevent infection at the tracheostomy site To facilitate healing and prevent skin excoriation around tracheostomy incision To promote comfort  NOTE:  Initially a tracheostomy may need to be suctioned as often as every 1 –  2 hours. After the initial inflammatory response subsides, it may done once or twice a day. Equipment: - Sterile disposable tracheostomy cleaning kit - Towel - Sterile suction kit - Hydrogen peroxide and sterile normal saline - Sterile gloves - Clean gloves - Sterile 4 x 4 gauze dressing - Cotton twill - Clean scissors

 Assessment: Assess Respiratory status Pulse rate Character and amount of secretions from tracheostomy site Presence of drainage Appearance of incision Steps / Procedure Identify and inform the client and explain the procedure. Wash hands and observe other appropriate infection control procedure Assist the client to a semi-Fowler’s or  Fowlers position Prepare the equipment, open the tracheostomy kit. Pour hydrogen peroxide into separate container Establish a sterile field, open other sterile supplies: tracheostomy dressing, suction Suction the tracheostomy tube After suctioning, wrap the catheter around your hand and peel the glove off  with the catheter inside the glove and discard Using the other gloved hand, unlock  the inner cannula (if  present) and remove it gently and place on the hydrogen peroxide solution Remove the soiled tracheostomy dressing, place the soiled dressing in

Rationale To allay anxiety

To promote lung expansion

 Hydrogen peroxide moisten and loosens dried secretions

Lecture Notes on Tracheostomy Care Prepared By: Mark Fredderick R Abejo R.N, M.A.N Clinical Instructor

your gloved hand and peel the glove off  with the soiled dressing and discard Put on another sterile gloves. Keep dominant hand sterile during the procedure. Clean the inner cannula:  Remove the inner cannula from the soaking solution  Clean the lumen and entire cannula thoroughly using a brush or pipe cleaners moistened with sterile NSS  Rinsing is important to  Rinse the inner remove hydrogen cannula thoroughly in the sterile normal  peroxide saline.  Using sterile technique, suction the outer cannula. Replace the inner cannula, securing it in place:  Insert the inner cannula by grasping the outer flange and inserting the cannula in the direction of its curvature.  Lock the cannula in place by turning the lock  (if present) into position to secure the flange of the inner cannula to the outer cannula. Clean the incision site and tube flange:  Using sterile applicators or gauze dressings moistened with normal saline, clean the incision site. Handle the sterile supplies with your dominant hand. Use each applicator or gauze dressing only once and then discard.  Hydrogen peroxide may be used to remove crustysecretions. Thoroughly rinse the cleaned area, using gauze squares moistened with sterile normal saline.  Clean the flange of the tube in the same manner.  Thoroughly dry the client’s skin and tube flanges with dry gauze squares.

Tape and pad the tie knot. Check the tightness of the ties. Document all relevant information.