TRACHEOSTOMY airway.
Necessary for patient on positive
pressure ventilation or when there is an
• Is created either temporary or permanent
increase oral or gastric secretion are present
through a surgical procedure through the neck
that may put the patient at risk for aspiration.
beneath the larynx, into the trachea (between
2-3 /3-4 tracheal rings) that serves as a place for Uncuffed Tubes - commonly used to patient
tracheostomy tube to maintain an artificial with good gag and coughing reflex in order to
airway. clear the secretions thus protecting them from
aspiration. No balloon to seal the airway.
EQUIPMENTS
✓ PPE
✓ Sterile normal saline
✓ Sterile cup of basin
✓ Sterile cotton tip applicator
✓ Sterile gauze sponges
✓ Disposable inner tracheostomy cannula, ensure
appropriate size
✓ Sterile suction catheter and glove set
TRACHEOSTOMY TUBE
✓ Commercially prepared tracheostomy or drain
• Is either metal or plastic hollow tube that is dressing
curved, and is inserted into the tracheotomy
✓ Commercially prepared tracheostomy holder
stoma to ease mechanical ventilation,
elimination of tracheal secretions and promote ✓ Pulse oximeter
patent airway.
✓ Tape and scissors
✓ Plastic disposable bag
✓ Obturator
✓ Additional nurse
ASSESSMENT
✓ Assess for the need to perform tracheostomy
care
✓ Assess for any skin redness or purulent
discharge at the insertion site
INDICATIONS FOR TRACHEOSTOMY
✓ Assess presence of pain (especially for the new
1. To enable long term airway management due to
tracheostomy), administer prescribed analgesic
airway obstruction, airway clearance needs.
before performing the procedure
2. To secure and maintain airway to patient with
✓ Check that lung sounds are equal in all lobes
face, head, neck injury
and with an oxygen saturation level above 93%
3. For patient who are at risk for aspiration
✓ Assess for any signs of skin breakdown around
TYPES OF TRACHEOSTOMY the posterior portion of the neck due to
pressure from tracheostomy ties or holder
Fenestrated tube – a tube with an opening on
the outer cannula to allow movements of air DIAGNOSIS
through the mouth and nose. Deflated cuff and
✓ Impaired skin integrity
without the inner cannula the patient can
speak. ✓ Ineffective airway clearance
Cuffed Tracheostomy Tube ✓ Risk for infection
Resembles an endotracheal tube, the end is ✓ Risk for aspiration
with soft balloon to be inflated sealing the
OUTCOME IDENTIFICATION & PLANNING 4. Posterior portion of the neck is free from skin
irritation or breakdown.
1. Tracheostomy tube (inner and outer cannula)
and site are free from to secretions, drainage, DOCUMENTATION
and skin irritation and breakdown.
1. Ensure to document the before and after
2. Oxygen saturation level will be within assessment
normal/acceptable level.
a. Site assessment
3. No signs of respiratory distress.
b. Presence of pain if any
4. Tube ties are clean and properly secured.
c. Lung sounds and oxygen
5. Stoma site is free from any secretions and saturation levels
bleeding, with no signs of infection.
2. Document if there is a resulting skin breakdown
IMPLEMENTATION or irritation due to tracheostomy collar pressure
on the skin.
1. Prepare and bring all the necessary equipment
to the bedside or overhead table. 3. Document the care rendered
2. Perform hand hygiene and put on PPE if UNEXPECTED SITUATIONS AND
necessary. INTERVENTIONS
3. Identify the patient.
4. Place pulse oximeter on the patient’s finger. 1. Dislodgement of tracheostomy due to hard
coughing
5. Ensure patient’s privacy is observe.
a. Ensure that a spare
6. Assess the need for tracheotomy care, and
tracheostomy tube and
presence of pain (administer prescribed pain
obturator is kept at
medication if needed)
bedside
7. Explain the rationale for performing the
b. Slip the obturator into
procedure. Reassure patient that any signs of
the new sterile
respiratory difficulty you will immediately stop.
tracheostomy and
8. Adjust the bed to a comfortable position, insert into the stoma.
possibly at elbow height
c. Remove the obturator.
9. Position the patient
d. Fix the ties and
1. Semi-fowler’s for conscious patient auscultate lung sounds
on all lobes.
2. Lateral position facing you for
unconscious patient e. Assess presence of
subcutaneous
10. Ensure that your equipment is close to the emphysema by
working area and is at your waist level. Trash palpation.
receptacle should be within your reach.
2. Presence of subcutaneous emphysema at the
11. Wear google/face shield and mask insertion site
12. Suction tracheostomy secretion if needed, if a. Assess if the
suctioning had just been done, removed soiled tracheostomy tube is
dressing and discard before removing your dislodged or displaced
gloves used for suctioning.
b. Notify the physician for
EVALUATION the presence of
1. Absence of drainage, secretions and skin subcutaneous
breakdown or irritation at the insertion site as emphysema
well as the tracheostomy tube. SPECIAL CONSIDERATION
2. Oxygen saturation level is within acceptable 1. Nurse is working alone
parameters
a. Remember to insert the
3. No evidence of respiratory distress new tracheostomy ties
in place before
removing the old one,
to prevent accidental
removal of
tracheostomy.
2. If the old ties need to be removed first ask for
assistance to secure the tracheostomy tube in
place, then you removed the old ties and
replaced it with new
3. Ensure that emergency equipment is always
accessible at bedside
a. Bag-valve mask
b. Oxygen
c. Obturator
d. Spare tracheostomy
tube of the same size,
and another one size
smaller
e. Suction equipment
f. Endotracheal tube
4. Keep spare tracheostomy with cuff at the
bedside for patient who is currently using
tracheostomy without a cuff, ensure that the
tracheostomy is of the same size of the patient’s
currently using.
5. Home care consideration:
a. Demonstrate and give
instruction to the
patient and caregiver
on how to
accomplished
tracheostomy care.
b. Let the care giver
perform return
demonstration and
ensure to give
feedback.
6. Clean technique can be used in the home
setting.
7. For a patient who is going to cleansed the
tracheostomy site, instruct to use a mirror when
performing the procedure
