Tracheostomy Care

by | Sep 11, 2024 | Nurse Article | 0 comments

Tracheostomy Care – Tracheostomy suctioning techniques, cleaning procedures, and emergency care for dislodged tracheostomy tubes.

Tracheostomy Care: Techniques, Procedures, and Emergency Management

A tracheostomy is a surgical procedure that creates an opening through the neck into the trachea (windpipe) to provide an airway for breathing. Proper care and maintenance of the tracheostomy site and tube are essential to ensure patient safety and prevent complications.

1. Tracheostomy Suctioning Techniques

Suctioning is performed to clear mucus or secretions from the tracheostomy tube to maintain an open airway.

a. Indications for Suctioning

  • Increased respiratory distress or difficulty breathing.
  • Visible secretions in the tracheostomy tube or around the stoma.
  • Coughing or gurgling sounds indicating obstruction.

b. Suctioning Procedure

  1. Prepare Equipment
    • Gather suction catheter, suction machine, sterile gloves, and a sterile container for secretions.
    • Set the suction machine to the appropriate pressure:
      • Adults: 80-120 mmHg.
      • Children: 60-100 mmHg.
      • Infants: 40-80 mmHg.
  2. Explain the Procedure
    • Inform the patient (if conscious) about the procedure to reduce anxiety.
  3. Prepare the Patient
    • Position the patient with the head in a neutral or slightly extended position.
    • Ensure oxygen and ventilation are adequate before suctioning.
  4. Suctioning Technique
    • Insert the Catheter: Gently insert the catheter into the tracheostomy tube until resistance is felt.
    • Apply Suction: Withdraw the catheter while applying suction (not exceeding 10-15 seconds) and rotate it to maximize clearance of secretions.
    • Oxygenate: Provide supplemental oxygen if needed between suctioning attempts.
    • Clean Equipment: Dispose of used suction catheter and clean the equipment according to facility protocols.
  5. Post-Suctioning Care
    • Monitor the patient for respiratory distress or changes in oxygen saturation.
    • Document the amount and type of secretions.

2. Cleaning Procedures

Routine Cleaning: Ensures the tracheostomy tube and stoma are free from infection and debris.

a. Tracheostomy Tube Cleaning

  1. Daily Cleaning
    • Remove the Tube: If it is a removable tube, follow facility protocols for removing and cleaning.
    • Clean the Tube: Use a brush and mild soap or prescribed cleaning solution. Rinse thoroughly with water.
    • Dry and Reinsert: Dry the tube completely before reinsertion. Ensure it is properly positioned and secured.
  2. Tube Replacement
    • Replace the tracheostomy tube as per the physician’s orders or facility protocols.

b. Stoma and Skin Care

  1. Daily Cleaning
    • Clean the skin around the stoma with mild soap and water. Avoid getting water into the stoma.
    • Pat the area dry with a clean towel or gauze.
    • Inspect the skin for signs of irritation, redness, or infection.
  2. Apply Dressing
    • Apply a clean, dry, sterile dressing around the stoma as needed.

c. Humidification

  • Use a humidifier or a tracheostomy collar to provide moisture to the air, preventing the drying of secretions.

3. Emergency Care for Dislodged Tracheostomy Tubes

A dislodged tracheostomy tube is a critical emergency that requires immediate action.

a. Immediate Actions

  1. Check the Airway
    • Assess the patient’s breathing and oxygenation status.
    • If the patient cannot breathe or is in severe distress, proceed with the following steps.
  2. Reinsert the Tube
    • If trained, attempt to reinsert the tracheostomy tube:
      • Lubricate the Tube: Use a sterile lubricant if available.
      • Insert the Tube: Gently insert the tube into the stoma and advance until resistance is met.
      • Secure the Tube: Once in place, secure the tube and check for proper placement (e.g., observe for respiratory sounds and chest movement).
  3. Use an Emergency Tube
    • If the original tube cannot be reinserted, use an emergency airway (e.g., an appropriately sized replacement tube or a tracheostomy kit).

b. Provide Ventilation

  1. Manual Ventilation
    • If necessary, provide manual ventilation with a bag-mask device or ambu-bag.
  2. Call for Help
    • Activate emergency protocols and call for additional medical assistance.

c. Assess and Monitor

  1. Monitor Vital Signs
    • Continuously monitor the patient’s vital signs and oxygen saturation.
    • Administer supplemental oxygen if required.
  2. Document the Incident
    • Record the time, actions taken, and patient’s response.

4. General Tips and Best Practices

  • Regular Monitoring: Regularly assess the patency of the tracheostomy tube and the condition of the stoma.
  • Education: Ensure that caregivers and family members are educated on tracheostomy care and emergency procedures.
  • Emergency Preparedness: Keep emergency supplies and replacement tubes readily available.

Summary

Effective tracheostomy care involves regular suctioning, cleaning, and vigilant monitoring to prevent complications. In emergencies, such as a dislodged tracheostomy tube, prompt and appropriate action is essential to secure the airway and provide adequate ventilation. Regular training and adherence to protocols ensure the safety and well-being of patients with tracheostomies.