Secretions from the tracheostomy site character and amount Presence of drainage on tracheostomy dressing or ties Appearance of incision redness, swelling, purulent discharge, or odor Planning Tracheostomy care involves application of scientific knowledge, sterile technique, and problem solving, and therefore needs to be performed by a nurse or respiratory therapist.
View Large In the case of an elective tracheostomy procedure performed in the intensive care unit, there remains debate about the timing of insertion.
Coupled with this, a tracheostomy provides many other beneficial effects for the patient when compared with tracheal intubation.
These include allowance of speech, increased comfort with oral hygiene care and suctioning, and earlier commencement of oral nutrition. An elective tracheostomy may be inserted as a percutaneous or open surgical technique.
Types of tracheostomy tube There are many different types and manufacturers of tracheostomy tubes and it is important to assess each patient carefully before planning a tracheostomy procedure. Further, when assessing a patient with a tracheostomy in situ, knowledge of several key elements about the tracheostomy tube is crucial: It is important to note the actual outer diameter dimensions rather than the notional size of the tube because different manufacturers produce tubes with different outer diameters.
For example, a size 7 tube always refers to an internal diameter of 7 mm, but the outer diameter will depend on the manufacturer. This is of particular consequence when changing the tracheostomy tube.
Is the tube a single lumen or double cannula tube?
A double cannula tracheostomy tube refers to a tube with both an outer and inner cannula, the latter being removable for cleaning to minimize the risk of blockage by encrusted secretions. Is the tube cuffed or cuffless? If the tube is of the double cannula type, is the outer cannula fenestrated or unfenestrated?
If the outer tube is fenestrated, is the inner tube fenestrated or unfenestrated? Patients with certain diseases may have specialized tracheostomy tube requirements.
For example, in the increasingly obese population, longer length tubes, such as the Bivona or Portex adjustable flange tubes, are commonly required. These have a moveable flange that allows the distance between the skin surface and distal end of the tube to be adjusted according to an individual patient's neck anatomy, so that the tube tip sits at an appropriate position in the trachea.
Such tubes are usually of the single-lumen variety, although double cannula longer length adjustable flange tubes are now being produced.
A double cannula tube, with an inner cannula that can be removed for cleaning, should be placed whenever possible because it is far less likely to become blocked than a single-lumen tube. These can be used in patients with large necks and also have the additional options of both inner cannulae, fenestrations, and may be cuffed or cuffless to aid weaning.
Other commonly used specialized tubes include: This device is a soft cuffless tube that lies flush with a patient's skin surface Fig.
It is used as an airway after tracheal reconstruction and in patients with tracheal stenosis.Tracheostomy Care – Management of Altered Airway The National NCEPOD report: On the Right Trach?
Revealed that over a quarter of hospitals managing patients with tracheostomy indicated that their staff had not received formal training in tracheostomy care and the . Tracheostomy: care and management review These guidelines are intended to support practitioners caring for children/young people with a Tracheostomy.
Quick reference algorithms are included in these guidelines for practitioner use. Insertion of a tracheostomy device is a common procedure in the operating theatre and critical care unit.
As a consequence, patients with a tracheostomy are now . To effectively care for a patient with tracheostomy, staffs are require to have the appropriate skills of respiratory assessment, an in-depth understanding of humidification, knowing when and how to suction, stoma care and management of .
A key concept of tracheostomy management is to ensure patency of the airway (tracheostomy tube). A blocked or partially blocked tracheostomy tube may cause severe breathing difficulties and this is a medical emergency.
Objectives Review of Evidenced-Based Guidelines in the Care & Maintenance Review Definition, Types of Tracheostomies & their uses Potential Complications.