Comprehensive Guide on our Tracheostomy Care
A tracheostomy is a surgical procedure that creates an opening (stoma) in the trachea to facilitate breathing when the upper airway is obstructed or compromised. Proper tracheostomy care is essential to prevent infections, maintain airway patency, and ensure patient comfort. This guide provides an in-depth overview of tracheostomy care, maintenance, complications, and nursing responsibilities.
1. Indications for Tracheostomy
A tracheostomy may be necessary for various medical conditions, including:
- Upper airway obstruction (e.g., tumors, severe inflammation)
- Prolonged mechanical ventilation (>14 days)
- Neuromuscular disorders (e.g., ALS, spinal cord injury)
- Congenital anomalies (e.g., laryngomalacia, tracheomalacia)
- Severe trauma to the face or neck
- Airway protection in unconscious patients
2. Types of Tracheostomy Tubes
Tracheostomy tubes come in different types based on patient needs:
A. Based on Cuff Presence
- Cuffed Tubes
- Prevents aspiration
- Used for mechanical ventilation
- Cuffless Tubes
- Allows speech
- Used for long-term tracheostomy
B. Based on Inner Cannula
- With Inner Cannula (Disposable/Reusable)
- Easier cleaning and maintenance
- Without Inner Cannula
- Less maintenance but requires frequent suctioning
C. Fenestrated vs. Non-Fenestrated
- Fenestrated Tubes (With openings)
- Facilitate speech when cuff is deflated
- Non-Fenestrated Tubes (No openings)
- Standard for mechanical ventilation
3. Tracheostomy Care Essentials
A. Equipment Needed
- Sterile gloves
- Normal saline
- Hydrogen peroxide (if needed)
- Suction catheter
- Sterile gauze
- Tracheostomy ties or Velcro strap
- Inner cannula (if applicable)
- Cotton-tipped applicators
- Oxygen source
B. Routine Tracheostomy Care Steps
1. Suctioning the Tracheostomy
(Performed every 4-8 hours or as needed based on patient secretions)
- Explain procedure to patient (if conscious).
- Position patient in semi-Fowler’s or Fowler’s position.
- Hand hygiene & wear PPE (sterile gloves, mask, face shield).
- Pre-oxygenate patient with 100% oxygen for 30-60 seconds.
- Insert suction catheter without applying suction.
- Withdraw catheter while applying suction in a circular motion (10-15 sec max).
- Allow patient to rest & repeat if necessary (max 3 passes per session).
- Monitor for complications (hypoxia, bradycardia, increased secretions).
2. Cleaning & Changing Tracheostomy Dressing
(Performed every 8-12 hours or when soiled)
- Hand hygiene & wear sterile gloves.
- Remove old dressing & inspect for signs of infection or irritation.
- Clean stoma site with sterile saline & cotton swabs.
- Apply a sterile gauze dressing under the tracheostomy plate.
- Secure the tracheostomy ties (ensure a snug fit but allow 1-2 fingers to fit).
3. Changing the Inner Cannula
- Remove the inner cannula carefully.
- Rinse with sterile saline or hydrogen peroxide (if reusable).
- Allow to dry & reinsert securely.
4. Potential Complications & Management
| Complication | Signs & Symptoms | Nursing Interventions |
|---|---|---|
| Tube Obstruction | Thick mucus, respiratory distress, wheezing | Suction airway, humidify air, increase hydration |
| Accidental Decannulation | Sudden breathing difficulty, distress | Keep emergency tracheostomy kit at bedside, replace tube immediately |
| Tracheostomy Site Infection | Redness, swelling, purulent discharge | Clean with sterile saline, administer antibiotics if needed |
| Tracheal Stenosis | Stridor, difficulty breathing | Monitor for narrowing, surgical intervention if severe |
| Aspiration | Coughing after eating, respiratory infections | Elevate head of bed, suction frequently, use a cuffed tracheostomy tube if needed |
5. Nursing Responsibilities
- Monitor respiratory status (oxygen saturation, breath sounds, effort).
- Maintain humidification to prevent mucus plug formation.
- Suction as needed to keep the airway clear.
- Educate caregivers on tracheostomy care and emergency management.
- Ensure emergency equipment (extra tracheostomy tube, obturator, suction) is available at the bedside.
6. Tracheostomy Decannulation & Weaning
- Patient must tolerate tracheostomy capping trials (gradual closure of the tube).
- Monitor for signs of airway compromise (stridor, difficulty breathing).
- Ensure the stoma is healing properly after decannulation.
7. Patient & Family Education
- Tracheostomy care techniques (cleaning, suctioning, dressing changes).
- Signs of infection or complications.
- Emergency procedures (what to do if the tube is dislodged).
- Speech and swallowing precautions.
Tracheostomy care is a critical nursing responsibility that requires meticulous airway management, infection prevention, and patient education. Our care givers follow best practices to enhance quality of life for individuals with tracheostomies.