Tracheostomy care Presented by, Mrs.Starina Flower, M.Sc (N) Asst. Professor, Medical Surgical Nursing Department, Annammal College Of Nursing, Kuzhithurai.

ANATOMY

TERMS Tracheotomy: Incision made below the cricoid cartilage through the 2nd-4th tracheal rings Tracheostomy: the opening or stoma made by this incision Tracheostomy Tube: Artificial airway inserted into the trachea

DEFINITION The word “tracheostomy” is derived from the Latin word “trachea” and “tomein” (to make an opening). Tracheostomy is an operative procedure that creates a surgical airway in the cervical trachea The surgical placement of a plastic or metal tube into the trachea to create an airway.

TRACHEOSTOMY INDICATIONS TO BYPASS OBSTRUCTION Tumors (oropharynx,larynx,upper trachea) Infections(epiglottitis,severe tracheobronchitis) Bilateral vocal cord paralysis) Trauma(laryngeal,facial fractures) Edema(tongue,larynopharynx) Intubation failure Foreign body obstruction

TRACHEOSTOMY INDICATIONS PROLONGED INTUBATION Neuromuscular diseases Paralyzing or weakening of chest muscles and diaphragm Cervical spinal cord injuries with respiratory muscles paralysis

TYPES OF TRACHEOSTOMY TUBE Uncuffed Cuffed Fenestrated

PARTS OF TRACHEOSTOMY TUBE flange PARTS OF TRACHEOSTOMY TUBE Outer cannula Inflation line cuff Pilot ballon

Flange - secured with tracheostomy ties Outer Cannula -tube connected to flange Inner Cannula - removable for cleaning Cuff -soft balloon around the end of the tube that can be inflated to allow for mechanical ventilation Obturator -a plastic guide with a smooth rounded tip that is used to guide the outer cannula during insertion PARTS OF TRACHEOSTOMY TUBE

Cuffed Tracheostomy tube Increase or improve ventilation/oxygenation Prevent aspiration with feeding tubes, decreased gag reflex & gastro-esophageal reflux Un-cuffed Tracheostomy tube Plastic or metal tube Allows air to flow freely around the tracheostomy tube through the larynx Reduces the risk of tracheal damage Damage

Fenestrated Tracheostomy tube Permits speech through the upper airway when the external opening is corked and the cuff is deflated Restores more of a normal airflow by allowing air to pass up and down the airway from the nose & mouth Allows secretions to be coughed out through mouth Inner Cannula Allows maintenance of tube patency Changing or cleaning the inner cannula helps to clear secretions Can be non-disposable or disposable

EQUIPMENT FOR TRACHEOSTOMY CARE Functioning Suction Suction catheters O2 for humidity Ambu bag Tracheostomy set of same size and type Sterile gloves Disposable inner cannulas or tracheostomy care tray for cleaning non-disposable Normal saline Hydrogen peroxide (for non-disposable inner cannulas cleaning) Sterile 4X4 gauze pad for dressing change Twill tapes

PROCEDURE Verify physician order Wash hand Explain the procedure Suction prior to care Oxygenate the patient Remove soiled dressings Discard the gloves used Open sterile tray. Pour normal saline into one bowl & hydrogen peroxide in another Don sterile gloves Unlock inner cannula and remove it. Soak inner cannula in hydrogenperoxide. Clean lumen and sides of inner cannula using sterile brush cont….. PROCEDURE

Rinse inner cannula in normal saline and replace it. Change dressing under the tracheostomy tube. Clean stoma and area around outer cannula in circular motion Place dry sterile precut gauze piece around tracheostomy stoma and under flange Change tracheostomy ties if needed. Bring both ties at one side of the client Use two square knots to secure ties. Remove gloves and discard disposables Assist patient to comfortable position Offer oral hygiene Wash hands Document the procedure

Complications Early complications Bleeding Air trapped around lungs Trauma to oesophagus Injuries to vocal cords Later complications Accidental removal Infection Erosion of trachea Narrowing of airway, blocked tube