Today our topic of discussion is Care of Tracheostomy Patients.
Care of Tracheostomy Patients
Care of the Tracheostomy Patient
- Maintain an open airway. Suction and clean the tube as indicated.
- Prevent aspiration, eg. of water, solutions, etc. through the tracheostomy.
- Keep materials which may occlude the tracheostomy, away from the opening, eg clothing, bedsheets
- Observe the patient carefully for indication of respiratory difficulty, eg, noisy respirators, restlessness, cyanosis, intercostals and substernal retraction, alterations in respiratory rate, labored respiration .
- Practice asepsis. Strict aseptic technique should be follo wed while suctioning, cleaning and dressing the wound .
- Observe for complications of tracheostomy.
- If the airway is obstructed, do suctioning, if the tracheostomy outer tube has come out, put the tracheal dilator inside and inform the doctor.
- Never try to push a blown out tracheostomy tube back into its place.
- Tracheal dilator and tracheal hook, sterile, should be present near the patient all the time
- Ensure maximal humidification of the inspired air and approximately warm inspired air.
- Sterile wet gauze covering the tracheostomy will help in humidification
- Provide adequate hydration to help liquefy pulmonary secretions.
- At least 3,000 ml. of intravenous fluids are ordered daily if adequate oral intake is not possible
- Maintain fluid and electrolyte balance.
- Keep an accurate intake and output chart Be gentle.
- The tracheal mucosa is easily traumatized during suctioning
- Keep the necessary articles like extra sterile inner tracheostomy tube, tracheal dilator, tape, vaseline, gauze, sterile gauze pieces, suction nozzles, sterile water and suction apparatus nearby
- Prevent pressure and trauma to the tracheobronchial tree.
- If a cuffed tube is being used, see that the cuff is deflated, as ordered, to relieve pressure periodically on the tracheal wall
- Periodically inspect the tracheostomy for trauma or infection
- Ensure use of a fresh tracheostomy tube as needed.
- Clean the inner cannula of mucus and encrustations as indicated.
- The inner tube is changed by nurses and outer tube by doctors
- Change the dressings and tracheostomy tube as necessary
- Provide approprial km cen. Kesp skreclean and dry
- Provide adequate andument
- Provide frequent mouth care to ininimize posside infection.
- Plenty of water should be given rally
- Administer medications as ordered.
- Narcotics and sedatives are usually avoided.
- To minimize apprehension, only mild tranquilizers are given
- For long-term cases, the patient and his relatives are taught how to take care of the tube
- Alleviate the patient’s apprehension by closely observing him, providing care in a calm but efficient manner and helping him communicate by providing a call bell.
- The suction procedure is as follows:
- Auscultate the chest before and after suctioning
- Wash hands and use sterile gloves
- Place a sterile towel across the patient’s chest just below the tracheostomy tube
- Clean the skin around the tube and the adaptors with a recommended antiseptic
- Select the catheter, attach it to the suction apparatus and lubricate it with sterile normal saline, gently insert into the tracheostomy tube and do the suctioning.
- It should not be continued more than 5 seconds at a time
- After suctioning, discard the catheter and gloves and also the saline.
- Note the amount and the character of the secretions aspirated
- Wash hands after completion of the procedure.
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