TRACHEOSTOMY CARE

To be able to understand and

learn the following :

• Anatomy and physiology of the

respiratory system
• Indications of tracheostomy OBJECTIVES
• Principles of tracheostomy care
• Types of tracheostomy
• Responsibilities of healthcare
staff in the care of patients
with tracheostomy
 ANATOMY
AND
PHYSIOLOGY
 Indications for tracheostomy

Obstruction of upper
Impaired respiratory
airway ( foreign body,
function (head trauma Facilitate removal of
trauma, infection,
leading to secretions.
laryngeal tumour, facial
unconsciousness).
fractures).

Protect/minimise risk of Assist in weaning from

aspiration in patients ventilatory support in
with poor/absent cough patients in intensive
reflex). care.
Principles of tracheostomy care

• Airway occlusion is the most serious complication arising from a

tracheostomy
 TYPES OF TUBES

Fenestrated cuffed tracheostomy tube:

This increases the risk for aspiration due
Cuffed with inner cannula: The inner
Cuff less tube with inner cannula: The to the fenestrations. The fenestrations
cannula may be either disposable or
inner cannula may be either disposable or also make it difficult to ventilate these
reusable. Cuff should be inflated only for
reusable. Good trach for people who don't patients. However, good for weaning off
positive pressure breaths. It must be
need to be on a ventilator. trach and for some patients who want to
deflated to use a speaking valve.
use a speaking valve. This type of tube is
good for long term ventilator patients.

Fenestrated cuff less tracheostomy tube:

Only used for patients who have difficulty
using a speaking valve with the other trach Metal tracheostomy tubes: Rarely used.
tubes. There are risks associated with Cannot use during MRI, and will cause
using fenestrations, such as aspiration and alarm during airport security checks.
granulation formation around the site of
the fenestrations
 Common Types of Tracheostomy Tubes

Portex Shiley Tracoe

Tracheostomy Tubes suctionaid
Cuffed tube with inner cannula Fenestrated tube
cuffed tube uncuffed tube
Speaking valve + tracheostomy

a one-way valve placed on the end of a cuffless, deflated

tracheostomy tube to facilitate normal speech.
• Dressing and tapes

• Cleaning equipment
• Gloves
• Oxygen- if applicable
 ESSENTIAL Suction
• yankuer sucker

/EMERGENCY
EQUIPMENT

SPARE TRACHEOSTOMY TUBE

CUFF PRESSURE
• Is required when a patient has a cuffed tracheostomy
• If pressures are too high can cause damage to the tracheal
tissue, such as necrosis and fistula formation through to the
oesophagus
• Should aim for optimum occlusion pressure usually
between 20-25cm H20
• BUT NEVER OVER 30 !!!
 HEALTHCARE STAFF RESPONSIBILITIES

1 2 3 4
Respiratory Suctioning Care of the Trouble
assessment stoma shooting
 PALLOR

CYANOSIS

BASIC DIFFICULTY IN
BREATHING
RESPIRATORY
IRRITABILITY
ASSESSMENT
PANIC

RECESSION
 SUCTIONING ADULTS

Suction should be set at <200mmHg Should take no longer than 15secs Requires a single pass technique

Indication:
•low saturations
•increased shortness of breath
Increased secretions sign of possible
•Congested sounded cough
•Coarse audible secretions
infection (amount, colour, thickness
•Visible secretions should be noted and GP informed)
•Indicated by the patient that suctioning is
necessary
IMPORTANT THINGS TO REMEMBER
WHEN SUCTION
• Use the right sized suction catheter
• Clean technique
• If appropriate oxygenate patient
beforehand
• If able ask your patient to cough
• Pass suction tube as far as end of trachy
and apply suction as you withdraw
• One suction catheter per suction
• Use a yankeur for oral secretions
 Once suction is
finished, a flush
Withdraw the of the catheter is
catheter required. Attach
completely –a

Procedure
Once catheter is a syringe with 5-
black mark 10mls of normal
advanced apply indicated when
suction and saline to the
the catheter has lumen and apply
perform the been withdrawn.
With your suctioning suction (ensuring
dominant hand, that the catheter
advance the has been fully
catheter within withdrawn)
the sleeve.
Attach the Support the
suction tracheostomy
tubing onto with your other
the closed hand.
suction port.
HUMIDIFICATION

People with tracheostomies bypass

their upper airway which humidifies
air

Types of Humidification
• Heat Moisture Exchange systems
(HME)
- provide humidification, maintain thin
secretions and prevents mucus plugs
- Prevents small particles entering the
trachea
• Humidified oxygen

• Nebulizer
• Swedish nose
- Cap that can be attached to the
tracheostomy tube to help maintain
humidity

• Buchanan bib
CARE OF STOMA

01 02 03 04 05
Observations- Daily cleaning Tape changes Changing Changing the
skin integrity, tracheostomy inner cannula
odour,
bleeding,
 Dislodgement

Blocked tracheostomy tube

Infection

COMPLICATIONS
Trauma

Bleeding

Hypoxia
COMMON EMERGENCIES !!!

TUBE DISPLACED
• Keep stoma open with tracheal dilators
• Oxygenate
• Call for help

TUBE BLOCKED
• Remove inner cannula and replace with spare
• Review humidification
TRANSPORT

At all times the client

should have
emergency equipment
with them.

This includes one trach

If ventilated should
same size and one If on oxygen should
have an Ambu Bag at
smaller in case of have spare oxygen
all times
dislodgement