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

2. ANATOMY

3. 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

4. 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.

5. 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

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

7. TYPES OF TRACHEOSTOMY TUBE
Uncuffed
Cuffed
Fenestrated

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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