Module 11: Management and Care of an Established Tracheostomy

Question 1

discuss why patients may require a tracheostomy tube

Answer 1

• trauma, vocal cord paralysis, foreign body, infection, neuromuscular disease, anaphylaxis, congenital, and malignancy

Question 2

Trach ties

Answer 2

fastened around the neck to hold the trash tube in place, attached to flange

Question 3

Corking/plugging

Answer 3

purposefully plugging the tube to allow patient to be weaned in preparation for decannulation

Question 4

Decannulation

Answer 4

removal of the trach tube

Question 5

Goals of Tracheostomy care

Answer 5

• to ensure airway patency by keeping the tube free from mucus buildup
• maintain mucous membrane and skin integrity
• prevent infection
• provide psychological support

Question 6

Management and Care of a Tracheostomy

Answer 6

• oxygen and suction available at all times
• suctioning only when assessments indicate that it is necessary
• two spare trach tubes at the bedside - one same size and one size smaller
• ambubag, spare inner cannula, obturator available and visible at the bedside
• communication method must be established
• respiratory therapist must be involved in patients care
• if trach is corked, the cuff must be deflated
• overinflating the cuff can cause tissue necrosis

Question 7

Special considerations for Tracheostomy

Answer 7

• appropriate humidification must be provided
• maintain adequate fluid status
• recommened referrals:
  
  • speech language pathologist (highly recommended)
  • dietician
  • physiotherapist

Question 8

Tracheostomy care

Answer 8

• dressing changes, stoma care and tie changes should only be done if necessary in first 24 hours
  
  • sterile technique used for dressing change and stoma care for first 72 hours
  • change the trash ties only when soiled or wet with 2 nurse present - one to hold teach insitu and one to change the ties
  • assess the stoma site and surrounding skin for redness, swelling and drainage
  • change the dressing frequently whenever secretions begin to collect and q8h minimum
  • assess and clean the inner cannula and stoma

Question 9

Common Complications associated with tracheostomy tubes

Answer 9

Within 72 hours 
- bleeding
- pneumothorax
- atelectasis 
- subcutaneous emphysema 
- respiratory arrest
- airway obstruction 
- tracheitis 
- cuff herniation
- cuff over inflation 
Possible complications
- infection - most common 
- tube displacement 
- tracheal damage 
- aspiration 
- accidental de-cannulation

Question 10

Weaning from a tracheostomy

Answer 10

• physicians order required
• patient/family may be very anxious about weaning
• optimal nutritional status will facilitate weaning
• readiness for decannulation
  
  • tolerates trash being corked x 24 hrs
  • minimal need for suctioning

Question 11

Demonstrate suctioning a tracheostomy tube

Answer 11

• goal: to improve O2 and CO2 exchange in the lungs by removing excessive mucous secretions
• Use sterile technique:
  
  • avoid introducing pathogens in the airway

Question 12

Documentation

Answer 12

• type and size of tracheostomy in situ
• skin integrity around tracheostomy site
• date of tracheostomy insertion/trach tube change
• assessment of respiratory system and status
• oxygen/humidty needs
• teach care procedures done:
  
  • suctioning
  • dressing change
• patient response