TRACHEOSTOMY

CARE
 To be able to understand and
learn the following :

• Anatomy and physiology of the

respiratory system OBJECTIVE
• Indications of tracheostomy
• Principles of tracheostomy care
S
• Types of tracheostomy
• Responsibilities of healthcare
staff in the care of patients
with tracheostomy
ANATOMY
AND
PHYSIOLO
GY
 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 to
Cuffed with inner cannula: The inner
Cuff less tube with inner cannula: The the fenestrations. The fenestrations also
cannula may be either disposable or
inner cannula may be either disposable or make it difficult to ventilate these patients.
reusable. Cuff should be inflated only for
reusable. Good trach for people who don't However, good for weaning off trach and
positive pressure breaths. It must be
need to be on a ventilator. for some patients who want to use a
deflated to use a speaking valve.
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

BASIC CYANOSIS

RESPIRAT DIFFICULTY IN
BREATHING
ORY
IRRITABILITY
ASSESSM
ENT 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
• Congested sounded cough Increased secretions sign of possible
• 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
a syringe with 5-
Once catheter is black mark 10mls of normal
advanced apply indicated when saline to the
suction and the catheter has lumen and apply
perform the been withdrawn.
With your suction (ensuring
suctioning
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
COMPLICAT
IONS 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

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