Definition of Tracheostomy – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Definition of Tracheostomy
A tracheostomy is an opening surgically created through the neck into the trachea to allow direct access to the breathing tube and is commonly done in an operating room under general anesthesia.
or
A tracheostomy is an artificial opening into the trachea, which is kept patent by the insertion of a metal or portex tube.
or
A tracheostomy describes the surgical procedure of creating an artificiar opening in une tracnea to relieve an obstruction of the airway. This artificial airway is maintained by a tube.
or
A tracheostomy is an artificial opening made into the trachea through which a curve tube, called tracheostomy.
Definition of Tracheostomy Tube:
Tracheostomy tube is a small metal or plastic tube that keeps the stoma (opening) and the trachea in a tracheostomy open. Also known as a trach (pronounced ‘trake’) tube.
Types of Tracheostomy Tube:
1. Single Lumen Tubes
2. Double Lumen Tubes
3. Uncuffed Tubes
4. Cuffed Tubes
5. Fenestrated Tubes
6. Adjustable flange tubes
or
A. Emergency tracheostomy.
B. Elective tracheostomy.
- a) Temporary tracheostomy
Importance/Purposes of Suctioning a Tracheostomy Tube:
1. To prevent damage of mucosal lining during suctioning.
2. Remove obstruction from the airway.
3. To make the safe of the life of patient.
4. To provide a method for mechanical ventilation of the patient.
5. To maintain airway potency.
6. To remove tracheobronchial secretions.
7. To promote cleanliness.
8. To prevent infection.
9. To prevent hypoxemia and hypoxia.
Indications of Tracheostomy:
Conditions that may require a tracheostomy include:
- Anaphylaxis
- Birth defects of the airway
- Burns of the airway from inhalation of corrosive material
- Cancer in the neck
- Chronic lung disease
- coma
- Diaphragm dysfunction
- Facial burns or surgery
- Infection Injury to the larynx or laryngectomy
- Injury to the chest wall
- Need for prolonged respiratory or ventilator support
- Obstruction of the airway by a foreign body
- obstructive sleep apnea
- Paralysis of the muscles used in swallowing
- Severe neck or mouth injuries
- Tumors
- Vocal cord paralysis
Complications of Tracheostomy:
Nursing Care Management for a Tracheostomy Patient:
A. Equipment
- Sterile disposable tracheostomy cleaning kit or supplies (sterile containers, sterile nylon brush or pipe cleaners, sterile applicators, gauze squares
- Sterile suction catheter kit (suction catheter and sterile container for solution)
- Sterile normal saline (Check agency protocol for soaking solution)
- Sterile gloves (2 pairs)
- Clean gloves
- Towel or drape to protect bed linens
- Moisture-proof bag
- Commercially available tracheostomy dressing or sterile 4-in. x -in. gauze dressing
- Cotton twill ties
- Clean scissors
B. Procedure:
1. Introduce self and verify the client’s identity using agency protocol. Explain to the client everything that you need to do, why it is necessary, and how can he cooperate. Eye blinking, raising a finger can be a means of communication to indicate pain or distress.
2. Observe appropriate infection control procedures such as hand hygiene.
3. Provide for client privacy.
4. Prepare the client and the equipment.
- To promote lung expansion, assist the client to semi-Fowler’s or Fowler’s position.
- Open the tracheostomy kit or sterile basins. Pour the soaking solution and sterile normal saline into separate containers.
- Establish the sterile field.
- Open other sterile supplies as needed including sterile applicators, suction kit, and tracheostomy dressing.
5. Suction the tracheostomy tube, if necessary.
- Put a clean glove on your no dominant hand and a sterile glove on your dominant hand (or put on a pair of sterile gloves).
- Suction the full length of the tracheostomy tube to remove secretions and ensure a patent airway.
- Rinse the suction catheter and wrap the catheter around your hand, and peel the glove off so that it turns inside out over the catheter.
- Unlock the inner cannula with the gloved hand. Remove it by gently pulling it out toward you in line with its curvature. Place it in the soaking solution. Rationale: This moistens and loosens secretions.
- Remove the soiled tracheostomy dressing. Place the soiled dressing in your gloved hand and peel the glove off so that it turns inside out over the dressing.
- Discard the glove and the dressing. Put on sterile gloves. Keep your dominant hand sterile during the procedure.
6. Clean the inner cannula.
- Remove the inner cannula from the soaking solution.
- Clean the lumen and entire inner cannula thoroughly using the brush or pipe cleaners moistened with sterile normal saline. Inspect the cannula for cleanliness by holding it at eye level and looking through it into the light
- Rinse the inner cannula thoroughly in the sterile normal saline.
- After rinsing, gently tap the cannula against the inside edge of the sterile saline container. Use a pipe cleaner folded in half to dry only the inside of the cannula; do not dry the outside.
7. Replace the inner cannula, securing it in place.
- Insert the inner cannula by grasping the outer flange and inserting the cannula in the direction of its curvature.
- Lock the cannula in place by turning the lock (if present) into position to secure the flange of the inner cannula to the outer cannula.
8. Clean the incision site and tube flange.
- Using sterile applicators or gauze dressings moistened with normal saline, clean the incision site. Handle the sterile supplies with your dominant hand. Use each applicator or gauze dressing only once and then discard.
- Hydrogen peroxide may be used (usually in a half-strength solution mixed with sterile normal saline; use a separate sterile container if this is necessary) to remove crusty secretions. Check agency policy. Thoroughly rinse the cleaned area using gauze squares moistened with sterile normal saline.
- Clean the flange of the tube in the same manner.
- Thoroughly dry the client’s skin and tube flanges with dry gauze squares.
9. Apply a sterile dressing
- Use a commercially prepared tracheostomy dressing of non- raveling material or open and refold a 4-in. x 4-in. gauze dressing into a V shape. Avoid using cotton-filled gauze squares or cutting the 4-in. x 4-in. gauze.
- Place the dressing under the flange of the tracheostomy tube.
- While applying the dressing, ensure that the tracheostomy tube is securely supported.
10. Change the tracheostomy ties.
- Change as needed to keep the skin clean and dry.
Post-Operative Nursing Care for a Tracheostomy Patient:
- Rest in bed.
- Patient should be kept in propped up position.
- Oxygen inhalation should be administered if needed.
- Suction.
- Humidification.
- Adequate fluid should be given.
- Administered antibiotic according to the doctor’s order to prevent infection.
- Analgesic if necessary.
- Monitoring vital signs.
- Wash of the inner tube by Sodium by carbonate solution 4 hourly.
- Calling bell, paper and pencil should be kept to the patient bed side.
Procedure of Suctioning a Tracheostomy Tube:
- Explain to the patient and their family that you are going to suction the tracheostomy tube
- Hand hygiene
- Use personal protective equipment including non-sterile gloves and safety glasses.
- Suction using a clean, non-touch technique.
- Attach suction catheter to suction tubing
- Gently introduce the suction catheter into the tracheostomy tube to the pre-measured depth.
- Apply suction & gently rotate the catheter while withdrawing. Each suction should not be any longer than 5-10 seconds.
- Assess the patient’s respiratory rate, skin colour and/or oximetry reading to ensure the patient has not been compromised during the procedure. Repeat the suction as indicated by the patient’s individual condition.
- Rinse the suction catheter with sterile water decanted into bowl, not directly from bottle.
- Look at the secretions in the suction tubing – they should be clear or white and move easily through the tubing.
- Notify the parent team if the secretions are abnormal, and consider sending a specimen for culture and sensitivity.
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