1. Tracheostomy
Care

2. Tracheostomy Care What is a Tracheostomy?
A surgical procedure performed to open an artificial airway in the neck through an incision in the trachea
A Tracheostomy is given when the pt is unable to maintain a patent airway and is at risk for severe respiratory distress.
Opening is made in the 2nd and 3rd tracheal rings
May be either temporary or permanent

4. Tracheostomy Tubes Double Cannula Tube Single-Cannula Tubes Cuffs
Outer cannual:
Holds the tracheostomy open, neck plate extends from the sides and has holes to attach cloth ties or Velcro strap around the neck
Inner cannula:
Acts as a removable liner for the more permanent outer tube can be withdrawn for brief periods to be cleaned lock into place to avoid being coughed out
Single-Cannula Tubes
Do not have an inner tube
For infants and small children
Generally not cuffed (even if mechanical ventilation is required)
Cuffs
An inflatable attachment of the tube
Occludes space between trachea walls and tube
Permits effective mechanical ventilation
Minimizes risk of aspiration
Pressure maintained less than 25cm H20 to prevent injury more than 20cm H20 to prevent aspiration

5. Tracheostomy Care How to clean a trach site:
Cleanse wound and plate with hydrogen peroxide and rinse with saline
Remove inner cannula and soak in hydrogen peroxide and rinse in saline solution
Apply new trach dressing
Change tape, secure new tape before removing old tape, for new trachs two people should remove tapes.

6. 1 – Vocal Cords
2 – Thyroid Cartilage
3 – Cricoid Cartilage
4 – Tracheal Cartilage
5 – Balloon Cuff

7. Tracheostomy Suctioning
WHY?
Decreased effectiveness of cough mechanism
Increased mucous production due to bypass of upper airway
WHEN?
Assess for need:
Adventitious breath sound present
Signs and symptoms with hypoxia present
Secretions are obvious or present
Unnecessary suctioning can cause bronchospasm and cause trauma to tracheal mucosa
HOW?
Sterile procedure: Any equipment to come in contact with lower air way
Suction should not exceed 120mm Hg
Hyperoxygenate for several deep breaths with adequate ventilation before, between and after suctioning
Insert tube without suction about 20 cm in adults
Apply suction while withdrawing and gently rotating catheter (prevents injury or mucosa)
no longer then 10 seconds
Reoxygenate and inflate lungs for a few deep breaths
Repeat steps until air way is clear
Assess respiration status before and after suctioning

9. Speech With a Tracheostomy
Plug the tracheostomy tube by holding a finger over the tube for short periods of time
Fenistrated trach tube:
Fenestration usually on greater curve of outer tube
When cuff is deflated and inner cannula is removed exhaled air passes over the vocal cords allowing client to talk
Indicated for client who have ability to speak and do not require mechanical ventilation
A tracheostomy speaking valve is a one-way valve that allows air in, but not out. This forces air around the tracheostomy tube, through the vocal cords and out the mouth upon expiration, enabling the client to vocalize. Speaking valves obviously cannot be used for complete airway obstruction.
Electrolarynx or Artificial larynx is a hand held device placed on the neck surface that vibrates when activated and mechanically resonates when words or sounds are mouthed.
A talking tracheostomy tube. Speech is obtained through a line directly above the cuff. An outside air source is used to force air through the vocal cords

10. Complications Early Complications: Long-term Complications:
Bleeding e.g. from divided thyroid isthmus
Pneumothorax
Air embolism
Aspiration
Subcutaneous or Mediastinal emphysema (presence of gas or air in these areas)
Recurrent laryngeal nerve damage
Posterior tracheal wall penetration
Long-term Complications:
Airway obstruction from secretions and mucus plugging or protrusion of cuff over opening of tube
Infection
Rupture of innominate artery (a short artery that arises from the arch of the aorta and divides into the carotid and subclavian arteries of the right side)
Dysphagia
Tracheoesophageal fistula
Trachea dialation or ischemia and necrosis
Tracheal stenosis may occur after tube removal
Preventing Complications
Administer adequate warmed humidity
Maintain cuff around tube
Assess respiratory status
Suction as needed using sterile technique
Maintain skin integrity: using sterile cleans site and tubing, change dressings and tape
Monitor signs and symptoms of infection
Administer oxygen as ordered, monitor O2 sats and signs of cyanosis

11. Teaching Client Self Care
Teach client and caregiver:
Emergency care and suctioning: clear airway and handle secretions
Proper technique for trach and stoma care, mouth care
Importance of humidification at home and avoiding air conditioning
Importance of wearing loose fitting protective cloth at the stoma to prevent foreign objects from entering the trach tube,
Prevent water form entering stoma e.g. cover when showering
Protect against breathing in really hot or cold air
Signs, symptoms and prevention of infections