Tracheostomy Care
Definition
A surgical opening in the trachea made in front of the neck to assist breathing - an artificial airway
An indwelling tube is inserted and maintained in place to keep the airway patent
Temporary or permanent
Indications
Anaphylactic shock with laryngeal edema
FB obstruction of the larynx
Stroke in COPD
Inability to clear airway through the nose or throat
Necessity to reduce the dead space to ease the efforts of breathing
Care of the Tracheostomy
At least once a day
Consists of sterile suctioning, change of soiled dressings
Patient should have a clean cloth or tissue to catch copious secretions that may be thrown out in a projectile cough
A complete set of emergency tracheostomy equipment should be always visible and available in bedside, in case the indwelling tube is accidentally dislodged or blocked
Keenly observe client’s reactions while caring is done
The emergency tracheostomy equipment is composed of:
a.) Sterile hemostat or dilator
b.) Extra sterile tracheostomy tube and obturator
c.) Suctioning machine and sterile suction catheters (oral and tracheal)
Assessment
Identify infection:
– Redness
– Swelling
– Bleeding or purulent discharges
– Character of secretions
Check the client’s:
– Respiratory status through oxygen saturation level, breath sounds, recent ABG and diagnostic results
– Look for Ineffective breathing pattern
-- Ability to maintain spontaneous ventilation
– Vital signs
– Cardiac rhythm
– High risk for impaired skin integrity
– Altered oral mucous membrane
- Impaired swallowing
– Risk for infection
– Fear
– Anxiety
– Situational low self- esteem
– Knowledge deficit
Implementation
Explain and inform the client
Hand washing prior to and after the procedure
Suction the oropharyngeal and tracheal areas thoroughly.
Allow the client to rest afterward prior to care
Place sterile towel around tracheostomy
Wear sterile gloves.
Clean the external portion of the indwelling tube with sterile gauze with hydrogen peroxide
Clean the stoma area with sterile gauzes soaked in normal saline solution
Remove crust or thick mucus plugs.
Apply antiseptic solution around the stoma
Change the tracheostomy tie: It should be changed every 24 hours or as needed if soiled frequently
One person prevents dislodgement of the tube.
The second person carries out the other actions.
a. Secure the tube by holding it in place but do not put pressure downward since it could stimulate cough reflex; while stabilizing the tube, cut or untie the soiled tape and remove carefully.
b. Remove any secretions underneath with sterile gauze and make sure it is dry.
c. Grasp slit end of clean tape and pull it through the small opening on the side. Do this on the other side.
d. Tie the tapes at the side of the neck - tight enough to allow two fingers to fit between the tape and the neck.
e. Insert dry sterile gauze between stoma and the tracheostomy tube to absorb the secretions.
f. Check for the client’s comfort
g. Document date and time of the procedure, findings
h. Teach self care and self change. Instrucr to Cover the hole with a moist cloth to humidify. Cove the hole with a cloth to avoid dust while going out
i Ask the patient to keep an extra tube with him always
i. Arrange for a speaking valve / refer to a speech therapist
