TRACHEOSTOMY CARE
INTRODUCTION
A tracheotomy is a surgical incision through the neck into the trachea. It helps opens the airway and aids
in breathing. A tracheotomy may be done in an emergency at the patient’s bedside or in an operating room.
Depending on the person’s condition, the tracheotomy may be temporary or permanent.
DEFINITION
Tracheotomy care includes changing a tracheotomy inner tube, cleaning tracheotomy site and changing
dressing around the site.
TYPES OF TRACHEOSTOMIES
1. Emergency
2. Prophylactic
INDICATIONS FOR TRACHEOSTOMY
Obstruction in the air passage in the upper part of trachea.
Unconscious patient with respiratory depression.
Patients with respiratory failure who need respiratory assistance for period longer than 1 to 2
days.
Patients who develop intolerance to endotracheal tube.
Patients undergoing major surgeries of the mouth and neck.
Patients with laryngeal and tracheal trauma and paralysis.
Patients receiving irradiation therapy for laryngeal tumors
Patients with head, neck and chest injuries.
Patients with accumulated secretions in the lower tracheobronchial tree which could cause
hypoxia
Patients with severe burns around the face and neck.
PURPOSES OF TRACHEOSTOMY CARE
To assess the condition of stoma.
To keep the tube free from mucous/to maintain patency of the tube.
To prevent the tube being pulled out or coughed out.
To watch the tracheotomy wound, and prevent infection.
To provide moist air for patient to breathe.
ARTICLES REQUIRED
1. A Sterile Tray Containing:
Sterile saline bottle
Sterile catheters (disposable)- size-14 for adults, 8-10 for children.
Sterile Gloves
Sterile bowls- 2
Glass Y connection
Sterile Syringe
2. Other Articles:
Suction Machine
Mackintosh and towel
Dressing set containing artery forceps and thumb forceps
Surgical drum containing sterile gauze pieces.
Antiseptic solution (Betadine)
TYPES OF TRACHEOSTOMY TUBE
1. Plastic
2. Metal
3. Cuffed
4. Uncuffed
5. Single Cannula
6. Double Cannula
7. Fenestrated
8. Infenestrated
PARTS OF TRACHEOSTOMY TUBE
Face Plate
Outer Cannula
Cuff
Pilot Balloon
Hub
Inner Cannula
PROCEDURE OF TRACHEOSTOMY CARE
Explain the procedure to the patient.
Screen the patient.
Bring the articles to the bedside and arrange them.
Put on the mask. Wash hands and dry them.
Protect the patient's garments with mackintosh and towel
Put on gloves, remove the inner tube from the T-tube and place it in a bowl containing water.
Switch on the suction machine with left hand and keeping right hand uncontaminated.
Pour sterile saline in sterile bowl with left hand.
Pick up the sterile catheter with right hand and attach it to the suction tubing.
Rinse the lumen of the catheter with saline in bowl.
Gently insert the catheter into the Tracheostomy tube 4-6 inches.
Do not apply suction while inserting the catheter.
Then slowly withdraw the catheter while rotating it. Don't apply suction for more than 15 seconds
to prevent hypoxia
Pick up a sterile gauze piece from the bowl and wipe off the catheter from top to the tip of the
catheter, once.
Discard the gauze in paper bag. Rinse the catheter again in sterile saline by right hand
Repeat the suction procedure until copious secretions are removed or patient is comfortable
Then discard the catheter.
Clean the tracheal site.
Soak the cotton tipped applicators in betadine solution for 10 seconds and clean around the
tracheal site.
Now soak a gauze piece in the cleaning solution and clean around the larger part of the neck or
tracheal site.
Change trach ties. Change the ties at least once a week.
Remove one side of the tie at a time. Keep one hand on the neck plate while the other unfastens
the tie. Remove one side of the tie, thread the new one through this side and fasten.
Unfasten the other side, remove, thread the rest of the new one and fasten securely.
When both sides are secure, place two fingers between the neck and the tie to make sure it is not
too tight. It needs to be snug but not tight.
Clean dirty inner cannula.
Discard the used supplies i.e. gauze pieces, catheter and cotton tipped applicators.
Remove gloves and wash hands. Make the patient comfortable.
GENERAL INSTRUCTIONS
Tracheostomy dressing should be done every 8 hours
If disposable inner cannula is present, then replace the one that is inside with a new one
If single lumen is present, then suction the tracheostomy tube and clean the neck plate and
tracheostomy site
Use rotator movements while withdrawing the catheter
Do not suction the patient more than 15 seconds at a time and rest at least 3 minutes between
Suctioning
For thick secretions, instill sterile saline solution about 0.5 ml. To 2 ml by a sterile syringe.
Remove the needle before instilling.
Aseptic technique should be maintained.
COMPLICATIONS
Poor ventilation due to tracheobronchial obstruction
Accidental expulsion during coughing
Infection of wound and lower respiratory tract
Prolonged suctioning leads to hypoxia
Hemorrhage from the site
Choking
Injury to the tracheal wall
NURSES RESPONSIBILITY
Be aware of when and why the tracheostomy was inserted, how it was performed, the type and
size of tube inserted
Examine the patient at the start of visit. Observe for signs of hypoxia, infection or pain.
Chest: Auscultate breath sounds
Examine tracheostomy tube, as well as stoma site for redness, purulent drainage, and bleeding
around the stoma
The majority of tracheostomy tubes have inner cannulas that require cleaning one to three times
daily unless they are disposable.
Use sterile technique to clean the reusable cannula with ½ strength hydrogen peroxide and normal
saline
Cuff pressure (balloon) should be maintained at 20 mmHg of pressure via a manometer-should
be assessed daily.
