Care of the patient with a tracheostomy

1. Care of the patient with a tracheostomy

2. WHAT IS A TRACHEOSTOMY? • A tracheostomy is a surgical opening in the anterior wall of the trachea just below the larynx. • It provides an alternative airway, bypassing the upper passages.

3. Types of tracheostomy • Temporary • Permanent • Emergency • Surgical • Percutaneous • Minitracheostomy • Cricothyroidotomy

4. TRACHEOSTOMY TUBES • A tracheostomy tube is:- • Inserted through the tracheostomy to maintain a patent airway • Secured in place by tapes tied around the neck

5. INDICATIONS • Upper airway obstruction. • Emergency airway access • Prolonged ventilation(e.g. ICU) • To provide and maintain a patent airway • To enable the removal of tracheobronchial secretions • To permit long term positive pressure ventilation • To improve patient comfort • To decrease the work of breathing and increase volume of air entering the lungs • As part of another procedure, for example, head and neck surgery.

6. CONTRAINDICATIONS • Difficult anatomy • Morbid obesity with short neck • Limited neck movement • Cervical spine injury – suspected or otherwise • Aberrant blood vessels • Thyroid or tracheal pathology • coagulopathy • Evidence of infection in the soft tissues of the neck at the insertion site

7. TYPES OF TRACHEOSTOMY TUBE • Uncuffed

8. TYPES OF TRACHEOSTOMY TUBE • Cuffed

9. TYPES OF TRACHEOSTOMY TUBE • Fenestrated

10. Anatomical positioning of a tracheostomy tube

11. Percutaneous tracheostomy insertion kit (rhino)

12. Percutaneous tracheostomy kit

13. Components of tracheostomy • Sizes range from 2.5mm to 11 mm • Curved tube • Inflatable cuff • Flanges with holes • Tube bladder

14. Peri-operative complications of tracheostomy • Haemorrhage • Surgical emphysema • Pneumothorax • Air embolism • Cricoid cartilage damage • Nerve damage

15. COMPLICATIONS ASSOCIATED WITH TRACHEOSTOMY TUBE PLACEMENT • Tracheal stenosis, ulceration, fibrosis, tracheomalacia • Loss of normal humidifying and warming mechanisms • Loss of physiological peep • Increased risk of nosocomial pneumonia

16. CARING FOR THE PATIENT • Having a tracheostomy can be very traumatic and many patients find it difficult to adjust. • Patients with a new tracheostomy will need lots of support, reassurance and education

17. Care of the patient with a tracheostomy • Safety first • Care of the stoma • Communication • Psychological • Nutrition • Infection control

18. SAFETY FIRSTWHEN CARING FOR A PATIENT WITH A TRACHEOSTOMY YOU MUST ENSURE THAT:- • There are spare tracheostomies available close by 1 the same size and the other a size smaller • A tracheal kit is close by • Suction equipment is available • Different size suction catheters available • Oxygen is available • Emergency equipment is available including a resuscitation bag and mask and defibrillator and emergency drugs

19. CARE OF THE STOMA / INFECTION CONTROL • The stoma has to be cared for carefully • It needs to be cleaned and inspected 2-3 times a day • It should be cleaned using aseptic technique and appropriate dressings applied to aid healing • Once tube is removed the stoma will close spontaneously over a few days

20. PSYCHOLOGICAL /COMMUNICATION • Patients and family require reassurance and support • Alternative methods of communication should be sought • Contact medical team for advice on communication • Provide stimulation in the form of television, radio, newspapers, etc

21. NUTRITION • Check local policy on eating and drinking with tracheostomies • Some trusts allow patients to eat and drink • Others do not!! • Usual ways of feeding include oral, nasogastric or parenteral.

22. SUMMARY • Patients with tracheostomies can be found in many health care environments from intensive care/high dependency to the community • Caring for patients with tracheostomies can be difficult but rewarding