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Tracheostomy Nursing Care and Management

A tracheostomy is a surgical way to beget an space through the neck into the trachea (windpipe). A tube is usually attributed through this space to get an airway and to dedistribute secretions from the lungs. This tube is indicated a tracheostomy tube or trach tube.
Definition of Terms
  • Decannulation: The way whereby a tracheostomy tube is departd uniformly resigned no longer insufficiencys it.
  • Humidification: The habitual way of increasing the introduce vapour gratified of an biblical gas.
  • Stoma: An space, either probconducive or surgically begetd, which connects a division of the association conconcavity to the beyond environment (in this subject, among the trachea and the foregoing demeanor of the neck).
  • Tracheostomy: A surgical way to beget an space among 2-3 (3-4) tracheal rings into the trachea inferiorneath the larynx.
  • Tracheal Suctioning: A resources of lustration condensed mucus and secretions from the trachea and inferior airway through the impression of privative influence via a suction catheter.
  • Tracheostomy tube: A deflexed smoothness tube of rubber or malleconducive inoculateed into the tracheostomy stoma (the respeak made in the neck and windpipe (Trachea) to succor airway impediment, arrange habitual balm or the opsituation of tracheal secretions.
Components of Tracheostomy Tube
  • Outer tube
  • Inner tube: Fits snugly into outlaterality tube, can be abundantly departd for spotlessing.
  • Flange: Flat malleconducive plate rooted to outlaterality tube – lies thriving counter the resigned’s neck.
  • 15mm outlaterality crossing termination: Fits all ventilator and respiratory equipment.
All cherishing features are optional
  • Cuff: Inflaconsultation air reservoir (lofty production, low influence) – succors anchor the tracheostomy tube in attribute and gets ultimatum airway sealing delay the last total of topical compression. To distend, air is injected via the…
  • Air entrance valve: One way valve that nullifys voluntary elude of the injected air.
  • Air entrance line: Route for air from air entrance valve to cuff.
  • Pilot cuff: Serves as an indicator of the total of air in the cuff
  • Fenestration: Respeak situated on the incurvation of the outlaterality tube – used to repair airflow in and out of the trachea. Single or multiple fenestrations are profitable.
  • Speaking valve / tracheostomy pin or cap: Used to occlude the tracheostomy tube space (a) preceding – during dulness to arrange oration and engulf, (b) dying – during twain revelation and dulness preceding to decannulation.
Providing Tracheostomy Care
  1. Explain way to resigned.
  2. If tracheostomy tube has been suctioned, remove dusky surroundings from encircling tube and dismiss delay gloves on opposition.
  3. Perform agency hygiene and disclosed essential anticipation.
Cleaning A Nonsuperfluous Vital Cannula
  1. Prepare anticipation antecedently spotlessing vital cannula.
    1. Open tracheostomy preservation kit and disalike basins, tender simply the edges. If kit is not available, disclosed two barren basins.
    2. Fill one basin fraction ½-inch (1.25 cm) occult delay hydrogen peroxide.
    3. Fill other basin fraction ½-inch (1.25 cm) occult delay distinguished.
    4. Open barren graze or pipe spotlessers if they are not already in spotlessing kit. Disclosed affixed barren gauze pad.
  2. Don superfluous gloves.
  3. Remove oxygen cause if one is give. Rotate lock on vital cannula in a counterclockwise turmoil to liberate it.
  4. Gently dedistribute vital cannula and preservationfully fall it in basin delay hydrogen peroxide. Dedistribute gloves and dismiss.
  5. Clean vital cannula.
    1. Don barren gloves.
    2. Remove vital cannula from soaking answer. Moisten graze or pipe spotlessers in distinguished and inoculate into tube, using back-and-forth turmoil.
    3. Agitate cannula in distinguished answer. Dedistribute and tap counter vital demeanor of basin.
    4. Place on barren gauze pad.
  6. Suction outlaterality cannula using barren technique.
  7. Reattribute vital cannula into outlaterality cannula. Spin lock clockwise and fashion unfailing that vital cannula is fasten. Reapply oxygen cause if insufficiencyed.
Replacing Superfluous Vital Cannula
  1. Release lock. Gently dedistribute vital cannula and attribute in superfluous bag. Dismiss gloves and don barren ones to inoculate new cannula. Reattribute delay unexceptionably sized new cannula. Engage lock on vital cannula.
Applying Spotless Surroundings and Tape
  1. Dip cotton-tipped applicator in distinguished and spotless stoma inferior faceplate. Use each applicator simply uniformly, tender from stoma post external.
  2. Apply hydrogen peroxide to area encircling stoma, faceplate, and outlaterality cannula if secretions argue up-hill to depart. Rinse area delay distinguished.
  3. Pat husk gently delay dry 4 x 4 gauze.
  4. Slide commercially easy tracheostomy surroundings or prefolded non-cotton-filled 4 x 4 surroundings inferior faceplate.
  5. Change tracheostomy tape.
    1. Leave dusky tape in attribute until new one is applied.
    2. Cut lot of tape that is twice the neck outline plus 4 inches (10 cm). Trim ends on the divergent.
    3. Insert one end of tape through faceplate space over-and-above old tape. Pull through until twain ends are smooth.
    4. Slide twain tapes inferior resigned’s neck and inoculate one end through cherishing space on other deviativeity of faceplate. Pull snugly and tie ends in double balance cluster. Stay that resigned can flex neck self-approvalably.
    5. Carefully dedistribute old tape. Reapply oxygen cause if essential.
  6. Remove gloves and dismiss. Perform agency hygiene. Assess resigned’s respirations. Document tolls and collection of way.
Lifespan Considerations
Infant and Child
  • An attendant may be essential during tracheostomy preservation to nullify free progeny from dislodging or expelling their tracheostomy tubes.
  • Always fashion a barren, packaged tracheostomy proficonsultation at bedlaterality for exigency purposes.
  • Encourage parents to share delay the way in an endeavor to self-approval the branch and excite client training.
  • Care for the husk at the tracheostomy post is main distinctly for the elders whose husk is past frail and prostrate to breakdown.
Home Preservation Modifications
  • Emphasize the consequence of agencywashing antecedently performing tracheostomy preservation.
  • Describe the capacity of each distribute of the tracheostomy tube.
  • Explain the own way on how to remove, modify, and reattribute the vital cannula.
  • Clean the vital cannula two or three dates a day.
  • Check and spotless the tracheostomy stoma.
  • Suction tracheal secretions if essential.
  • Assess for symptoms of contagion (i.e., increased air, increased total of secretions, modify in complexion or effluvium of secretions).
  • Advise and permit parents to share delay the way in an endeavor to self-approval the branch and excite client training.
  • Provide continuity advice for emergencies.
[embed]https://www.youtube.com/watch?v=9xoTaPIHjgk[/embed]
Suctioning a Tracheostomy Tube
Suctioning of tracheostomy tube is simply done as essential.  Barren technique must be observed. Nurses should be informed that there is a number for the insufficiency of suctioning during contiguous postoperative date.
 
Purposes
  • Removes condensed mucus and secretions from the trachea and inferior airway to conceal plain airway and nullify airway impediments
  • To excite respiratory capacity (optimal exmodify of oxygen and carbon dioxide into and out of the lungs)
  • To nullify pneumonia that may conclusion from accumulated secretions
Assessment
  • Assess the client for the nearness of congeries on auscultation of the thorax.
  • Note the client’s ability or weakness to dedistribute the secretions through coughing.
Planning
Suctioning a tracheostomy or endotracheal tube is a barren, invasive technique requiring impression of or-laws apprehension and height solving. This expertness is done by a foster or respiratory therapist and is not procuratorial to UAP.
Equipment
  • Resuscitation bag (Ambu bag) alike to 100% oxygen
  • Sterile towel (optional)
  • Equipment for suctioning
  • Goggles and hide if essential
  • Gown (if essential) as Barren gloves
  • Moisture-resistant bag
Preparation
Determine if the client has been suctioned previously and, if so, critique the documentation of the way. This advice can be very advantageous in preparing the foster for twain the physiologic and psychologic collision of suctioning on the client
Procedure
  1. Explain the way to the resigned and reasunfailing him or her that you succeed misappertain the way if the resigned indicates respiratory up-hilly. Administer pain medication to postoperative resigned antecedently suctioning.
  2. Gather equipment and get seclusion for resigned.
  3. Perform agency hygiene.
  4. Assist the resigned to a semi-Fowler’s or Fowler’s situation if sensible. An unsensible resigned should be attributed in the deviative situation oppositeness you.
  5. Turn suction to misapply influence.
    1. Wall unit
      1. Adult: 100 to 120 cm Hg
      2. Child: 95 to 110 cm Hg
      3. Infant: 50 to 95 cm Hg
    2. Porconsultation unit
      1. Adult: 10 to 15 cm Hg
      2. Child: 5 to 10 cm Hg
      3. Infant: 2 to 5 cm Hg
  6. Place spotless towel, if life used, over resigned’s chest. Don goggles, hide, and gown, if essential.
  7. Open barren kit or set up equipment and lay to suction.
    1. Place barren endue, if profitable, over resigned’s chest.
    2. Open barren container and attribute on bedlaterality consultation or overbed consultation delayout contaminating vital demeanor. Pour barren distinguished into it.
    3. Hyperoxygenate resigned using manual resuscitation bag or pine contrivance on habitual ventilator.
    4. Don barren gloves or one barren glove on dominant agency and spotless glove on nondominant agency.
    5. Connect barren suction catheter to suction tubing held delay unbarren gloved agency.
  8. Moisten catheter by dipping it into the container of barren distinguished, regular it is one of the newer silicone catheters that does not insist-upon isolation.
  9. Remove oxygen introduction setup delay unbarren gloved agency if it is calm?} in attribute.
  10. Using barren gloved agency, gently and undeviatingly inoculate catheter into the trachea. Advance environing 10 to 12.5 cm (4-5 inches) or until resigned coughs. Do not occlude Y-port when inoculateing catheter.
  11. Apply interrupted suction by occluding Y-port delay thumb and refutation finger of barren gloved agency as catheter is life delaydraw. Do not afford suctioning to dwell for past than 10 seconds. Hyperrefrigerate three to five dates among suctioning or permit resigned to cough and occult murmur among suctioning.
  12. Flush catheter delay distinguished and cite suctioning as insufficiencyed and according to resigned’s tolerance of the way. Afford resigned to pause at last 1 searching among suctioning, and reattribute oxygen introduction setup if essential. Limit suctioning smoothts to three dates.
  13. When way is accomplishedd, spin off suction and misappertain catheter from suction tubing. Dedistribute gloves inlaterality out and appoint of gloves, catheter, and container delay answer in own lodgment. Perform agency hygiene.
  14. Adjust resigned’s situation. Auscultate chest to evaluate inhalation sounds.
  15. Record date of suctioning and constitution and total of secretions. Also voicelessness sign of resigned’s respirations antecedently and following suctioning.
  16. Offer spoken hygiene.
Lifespan Considerations
Infant and Child
  • Restrain the branch gently delay the succor of an attendant and conceal the branch’s topic in the midline situation.
  • To be informed of any proper heights, do a powerful lung toll antecedently and following the wrespeak way.
Home Preservation Considerations
  • Encourage the client to acquitted airway by coughing, if potential.
  • If cannot cough ownly, permit the client to suction their secretions.
  • Advise the client or preservationgiver to use spotless gloves in performing the way.
  • The foster should enlighten the preservationgiver on how to indicate the insufficiency for suctioning.
  • Discuss to the preservationgiver the reform way and rationale inferiorlying the performance of suctioning.
  • Emphasize the consequence of exuberant hydration as it thins secretions, which can aid in the opsituation of secretions by coughing or suctioning.
Dealing delay Emergencies
If the tracheostomy tube falls out
  1. DON’T PANIC!
  2. Once the tracheostomy tube has been in attribute for environing 5 days the charge is well-mannered-mannered formed and succeed not suddenly halt.
  3. Reasunfailing the resigned
  4. Call for medical succor.
  5. Ask the resigned to murmur recognizedly via their stoma time indecision for the master.
  6. The alight redintegration (if give) or tracheal dilator may be used to succor repress the stoma disclosed if essential.
  7. Stay delay resigned.
  8. Prepare for inoculateion of the new tracheostomy tube
  9. Once substituted, tie the tube fastenly, leaving one finger-space among ties and the resigned’s neck.
  10. Check tube situation by (a) asking the resigned to snuff occultly – they should be conducive to do so abundantly and self-approvalably, and (b) dwell a lot of structure in face of the space – it should be “blown” during resigned’s effluvium.
Patient is having Acute Dyspnea
Acute dyspnea for resigned delay tracheostomy is most commsimply caused by distributeial or accomplished blockage of the tracheostomy tube retained secretions. To unblock the tracheostomy tube:
  1. ASK THE PATIENT TO COUGH: A cogent cough may be all that is insufficiencyed to expectorate secretions.
  2. REMOVE THE INNER CANNULA: If there are secretions stuck in the tube, they succeed automatically be departd when you transfer out the vital cannula. The outlaterality tube – which does not keep secretions in it – succeed afford the resigned to inhalation spontaneously. Spotless and reattribute the vital cannula.
  3. SUCTION: If coughing or retender the vital cannula do not production, it may be that secretions are inferior down the resigneds airway. Use the suction muniment to dedistribute secretions.
  4. If these measures trip – begin low ardor oxygen therapy via a tracheostomy hide, and fawn for medical countenance.
It is potential that the tracheostomy may keep behove displaced. Alight delay the resigned until countenance arrives. Lay for modify of tracheostomy tube.
Patient insufficiencying Cardiopulmonary Resuscitation
In the smootht of cardiopulmonary apprehend, speak tracheostomy resigneds as other resigneds:
  1. Step 1: Expose the resigned’s neck. Dedistribute any investment covering the tracheostomy tube and the neck area. Do not dedistribute tracheostomy.
  2. Step 2: Stay the patency of the vital cannula. To stay vital cannula: Wearing a non-barren glove, dedistribute  vital cannula. If spotless, reinoculate and lock into attribute. If dusky – substitute. Dwell resuscitation.
  3. Step 3: Ventilate. Use the ambu-bag quickly to the t-tube.
  4. If unconducive to refrigerate:
    • Try to suction. To dedistribute or acquitted the secretions blocking the tube.
    • If calm?} unconducive to refrigerate. The tube may be displaced and the master may:
      • Change the tube
      • Intubate spokenly

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