1. Care of the patient with a tracheostomy

2. WHAT IS A TRACHEOSTOMY?
A tracheostomy is a surgical opening in the anterior wall of the trachea just below the larynx.
It provides an alternative airway, bypassing the upper passages.

3. Types of tracheostomy Temporary Permanent Emergency Surgical
Percutaneous
Minitracheostomy
Cricothyroidotomy

4. TRACHEOSTOMY TUBES A tracheostomy tube is:-
Inserted through the tracheostomy to maintain a patent airway
Secured in place by tapes tied around the neck

5. INDICATIONS Upper airway obstruction. Emergency airway access
Prolonged ventilation(e.g. ICU)
To provide and maintain a patent airway
To enable the removal of tracheobronchial secretions
To permit long term positive pressure ventilation
To improve patient comfort
To decrease the work of breathing and increase volume of air entering the lungs
As part of another procedure, for example, head and neck surgery.

6. CONTRAINDICATIONS Difficult anatomy Morbid obesity with short neck
Limited neck movement
Cervical spine injury – suspected or otherwise
Aberrant blood vessels
Thyroid or tracheal pathology
coagulopathy
Evidence of infection in the soft tissues of the neck at the insertion site

7. TYPES OF TRACHEOSTOMY TUBE
Uncuffed

8. TYPES OF TRACHEOSTOMY TUBE
Cuffed

9. TYPES OF TRACHEOSTOMY TUBE
Fenestrated

10. Anatomical positioning of
a tracheostomy tube

11. Percutaneous tracheostomy insertion kit (rhino)

12. Percutaneous tracheostomy kit

13. Components of tracheostomy
Sizes range from 2.5mm to 11 mm
Curved tube
Inflatable cuff
Flanges with holes
Tube bladder

14. Peri-operative complications of tracheostomy
Haemorrhage
Surgical emphysema
Pneumothorax
Air embolism
Cricoid cartilage damage
Nerve damage

15. COMPLICATIONS ASSOCIATED WITH TRACHEOSTOMY TUBE PLACEMENT
Tracheal stenosis, ulceration, fibrosis, tracheomalacia
Loss of normal humidifying and warming mechanisms
Loss of physiological peep
Increased risk of nosocomial pneumonia

16. CARING FOR THE PATIENT
Having a tracheostomy can be very traumatic and many patients find it difficult to adjust.
Patients with a new tracheostomy will need lots of support, reassurance and education

17. Care of the patient with a tracheostomy
Safety first
Care of the stoma
Communication
Psychological
Nutrition
Infection control

18. SAFETY FIRST WHEN CARING FOR A PATIENT WITH A TRACHEOSTOMY YOU MUST ENSURE THAT:-
There are spare tracheostomies available close by 1 the same size and the other a size smaller
A tracheal kit is close by
Suction equipment is available
Different size suction catheters available
Oxygen is available
Emergency equipment is available including a resuscitation bag and mask and defibrillator and emergency drugs

19. CARE OF THE STOMA / INFECTION CONTROL
The stoma has to be cared for carefully
It needs to be cleaned and inspected 2-3 times a day
It should be cleaned using aseptic technique and appropriate dressings applied to aid healing
Once tube is removed the stoma will close spontaneously over a few days

20. PSYCHOLOGICAL /COMMUNICATION
Patients and family require reassurance and support
Alternative methods of communication should be sought
Contact medical team for advice on communication
Provide stimulation in the form of television, radio, newspapers, etc

21. NUTRITION
Check local policy on eating and drinking with tracheostomies
Some trusts allow patients to eat and drink
Others do not!!
Usual ways of feeding include oral, nasogastric or parenteral.

22. SUMMARY
Patients with tracheostomies can be found in many health care environments from intensive care/high dependency to the community
Caring for patients with tracheostomies can be difficult but rewarding