A tracheostomy is an opening created in the trachea to allow for an alternative airway. It can be temporary or permanent. The document discusses the anatomy of the tracheostomy, indications for the procedure, different types of tracheostomy tubes, and nursing care considerations like suctioning, humidification, cleaning and dressing changes. Proper tracheostomy care is needed to maintain airway patency, prevent infection, and promote patient comfort.

2. TRACHEOSTOMY
Ms.Sweta Bijukshe
Lecturer
BMI

3. ANATOMY

4. Definition
 A tracheostomy is an artificial opening/or
surgical opening made into the trachea
,making an opening in the anterior wall of
trachea and converting it into a stoma on the
surface of skin is called tracheostomy.
 It provides an alternative airway, bypassing the
upper passages.
 A tracheostomy may be either temporary or
permanent.

5. Proper Placement

6. An opening into the trachea usually between
the second and third rings of cartilage.

7. Functions of Tracheostomy
 Alternative pathway for breathing
:this circumvents any obstruction in the
upper airway from lips to the
tracheostome.
 Improves alveolar ventilation :In case
of respiratory insufficiency alveolar
ventilation is improved

8. Functions of Tracheostomy
 Protects the airways :by using cuffed tube,
tracheobronchial tree is protected against
aspiration of:
 Pharyngeal secretions ,as in case of bulbar
paralysis or coma
 Blood ,as in hemorrhage from pharynx, larynx
or maxillofacial injuries. With tracheostomy,
pharynx & larynx can also be packed to control
bleeding.
 Permits removal of tracheobronchial
secretions
 Intermittent positive pressure respiration
(IPPR)
 To administer anesthesia

9. Indication
 Respiratory obstruction
 Retained secretions
 Respiratory insufficiency

10. Respiratory obstruction
1.Infections
-Acute laryngo- tracheo-bronchitis, acute epiglottitis,
diphtheria,
retropharyngeal abscess
2.Trauma
-External injury of larynx & trachea
-Trauma d/t endoscopies
-Fractures of mandible or maxillofacial injuries
3.Neoplasms
-Benign & malignant neoplasm of larynx, pharynx, upper
trachea, thyroid
4.Foreign body larynx

11. Retained secretions
Unconscious patient following head
injury and narcotic overdose (poisoning).
Paralysis of respiratory muscles e.g.
spinal injuries, Guilain-Barre syndrome,
myasthenia gravis.
Spasm of respiratory muscles ,tetanus

12. Respiratory insufficiency
 Chronic lung conditions, viz.
emphysema, chronic bronchitis,
bronchiectasis, atelectasis

13. TYPES OF
TRACHEOSTOMY
 Temporary
 Permanent
 Minitracheostomy
(Cricothyroidotomy)

14. MINITRACHEOSTOMY

15. PARTS

16. TYPES OF TRACHEOSTOMY
TUBES
 Plastic or metal
 Cuffed or uncuffed
 Fenestrated or unfenestrated
 Double canula or single canula

17. TYPES OF TRACHEOSTOMY
TUBE
 PLASTIC
 METAL

18. TYPES OF TRACHEOSTOMY
TUBE
 UNCUFFED
 CUFFED

19. TYPES OF TRACHEOSTOMY
TUBE
FENESTRATED
UNFENESTRATED

20. TYPES OF TRACHEOSTOMY
TUBES
 SINGLE CANULA
 DOUBLE CANULA

22. Purpose of care
 To maintain airway patency by removing
mucus and encrusted secretions.
 To maintain cleanliness and prevent
infection at the tracheostomy site
 To facilitate healing and prevent skin
excoriation around the tracheostomy
incision
 To promote comfort

23. • Be aware of when and why the trach
was inserted , how it was performed,
the type and size of tube inserted
 Examine the patient at the start of
visit. Observe for signs of hypoxia,
infection or pain
• Chest: Auscultate breath sounds
• Examine trach tube, as well as stoma
site for redness, purulent drainage,
and bleeding around the stoma
Nursing Care:
Examination/Assessment

24.  The nose provides
warmth, moisture and
filtration for the air we
breath.
 Having a tracheostomy
tube by-passes these
mechanisms
 so humidification must
be provided to keep
secretions thin and to
avoid mucus plugs
Tracheostomy Humidification

25. Equipments

26. Procedure for suctioning

27. Introduce self and verify the client’s identity using
agency protocol.
Explain to the client everything that you need to do,
why it is necessary, and how can he cooperate. Eye
blinking, raising a finger can be a means of
communication to indicate pain or distress.
1

28. 2
Perform hand hygiene

29. 3
Provide for client privacy.

30. 4
Prepare the client and the equipment.
 To promote lung expansion, assist the client to semi-
Fowler’s or Fowler’s position.
 Open the tracheostomy kit or sterile basins. Pour the
soaking solution and sterile normal saline into
separate containers.
 Establish the sterile field.
 Open other sterile supplies as needed including sterile
applicators, suction kit, and tracheostomy dressing.

31. 5
Suction the tracheostomy tube, if necessary
 Put a clean glove on your nondominant hand and a sterile
glove on your dominant hand (or put on a pair of sterile
gloves).
 Suction the full length of the tracheostomy tube to remove
secretions and ensure a patent airway.
 Rinse the suction catheter and wrap the catheter around
your hand, and peel the glove off so that it turns inside out
over the catheter.

32. Contd…
Unlock the inner cannula with the gloved hand.
Remove it by gently pulling it out toward you in
line with its curvature. Place it in the soaking
solution. Rationale: This moistens and loosens
secretions.
Remove the soiled tracheostomy dressing. Place
the soiled dressing in your gloved hand and peel
the glove off so that it turns inside out over the
dressing. Discard the glove and the dressing.
Put on sterile gloves. Keep your dominant hand
sterile during the procedure

33. 6
Clean the inner cannula
 Remove the inner cannula from the soaking solution.
 Clean the lumen and entire inner cannula thoroughly using
the brush or pipe cleaners moistened with sterile normal
saline. Inspect the cannula for cleanliness by holding it at
eye level and looking through it into the light.
 Rinse the inner cannula thoroughly in the sterile normal
saline.

34. Contd….
 After rinsing, gently tap the cannula against the
inside edge of the sterile saline container.
 Use a pipe cleaner folded in half to dry only the
inside of the cannula; do not dry the outside.
 Rationale: This removes excess liquid from the
cannula and prevents possible aspiration by the
client, while leaving a film of moisture on the
outer surface to lubricate the cannula for
reinsertion.

35. 7Replace the inner cannula, securing it in place.
Insert the inner cannula by grasping the outer
flange and inserting the cannula in the
direction of its curvature.
Lock the cannula in place by turning the lock
(if present) into position to secure the flange of
the inner cannula to the outer cannula.

36. 8
Clean the incision site and tube flange.
Using sterile applicators or gauze dressings
moistened with normal saline, clean the incision
site. Handle the sterile supplies with your
dominant hand. Use each applicator or gauze
dressing only once and then discard. Rationale:
This avoids contaminating a clean area with a
soiled gauze dressing or applicator.

37.  Hydrogen peroxide may be used (usually in a
half-strength solution mixed with sterile
normal saline; use a separate sterile container
if this is necessary) to remove crusty
secretions. Check agency policy. Thoroughly
rinse the cleaned area using gauze squares
moistened with sterile normal saline.
 Rationale: Hydrogen peroxide can be
irritating to the skin and inhibit healing if not
thoroughly removed.

38. Contd…
Clean the flange of the tube in the same
manner.
Thoroughly dry the client’s skin and tube
flanges with dry gauze squares

39. 9Apply a sterile dressing
 Use a commercially prepared tracheostomy dressing of non-
raveling material or open and refold a 4-in. x 4-in. gauze dressing
into a V shape. Avoid using cotton-filled gauze squares or cutting
the 4-in. x 4-in. gauze. Rationale: Cotton lint or gauze fibers can be
aspirated by the client, potentially creating a tracheal abscess.
 Place the dressing under the flange of the tracheostomy tube.
 While applying the dressing, ensure that the tracheostomy tube is
securely supported. Rationale: Excessive movement of the
tracheostomy tube irritates the trachea.

40. 1
0Change the tracheostomy ties
 Change as needed to keep the skin clean and dry.
 Twill tape and specially manufactured Velcro ties are
available. Twill tape is inexpensive and readily available;
however, it is easily soiled and can trap moisture that
leads to irritation of the skin of the neck.
 Velcro ties are becoming more commonly used. They are
wider, more comfortable, and cause less skin abrasion.

41. Contd…
 Document all relevant information.
 Record suctioning, tracheostomy care,
and the dressing change, noting your
assessments.

42. video
https://www.youtube.com/watch?v=90Dt
iYJMQ4o

43. Sample Documentation
 7/26/2017 Respirations 18-20/min.
Lung sounds clear. Able to
expectorate secretions requiring
little suctioning. Large amount of thick
secretions cleansed from inner
cannula. Inner cannula changed.
Trach dressing changed. Skin around
trach is intact but slightly red in color
0.2 cm around entire opening. No
broken skin noted in the reddened
area. — G. Wayne, RN

44. Nursing
Management

45. Nursing diagnosis
1. Ineffective airway clearance r/t presence of
tracheostomy tube & difficulty expectorating
sputum as evidence by adventitious breath
sound, tenacious secretions
2. Impaired verbal communication r/t presence
of tracheostomy tube as evidenced by
inability to speak
3. Impaired swallowing r/t tracheostomy tube as
evidence by inability to swallow without
difficulty & /or without aspiration

46. Nursing diagnosis
4.Disturbed body image related to presence of
tracheostomy
5.Ineffective therapeutic regimen management
r/t lack of knowledge about care of tracheostomy
at home as evidence by questioning about care.
6.Risk for infection r/t by pass of upper airway
defense mechanisms & impaired skin integrity

47. 1. Maintain airway
 Assess amount, color, consistency of secretion
 Auscultate breath sounds, noting areas of
decreased or absent ventilation & presence of
adventitious sounds.
 Remove secretions by encouraging coughing
or by suctioning to clear airway.
 Encourage ambulation as able, or turn every 2
hrs and encourage fluids if not contraindicated
(fluids help hydrate secretions, making them
eaiser to cough up).

48. Maintain airway
 Encourage slow deep breathing ,turning,&
coughing to assist in mobilizing secretions
 Position to alleviate dyspnea (head of bed
elevated 30-40 degrees) to allow maximum
lung expansion
 Provide 100% humidification of inspired
gas/air because normal upper airway
humidification not present.

49. 2. Improve verbal communication
 Assess patient ability to understand the spoken
word & Assess patents ability to expression.
 Listen attentively .Take time to allow patient to
communicate needs.
 Watch for patient’s nonverbal cues.
 Use pictures board (offer pen and paper).
 Provide information to patient about condition

50. Improve verbal communication
 Provide reassurance about patients condition
to allay fear and frustration.
 Instruct patient on measure to
control/minimize symptoms to permit speech.

51. 3. Improve swallowing
 Provide/monitor consistency of
food/liquid based on findings of
swallowing study to ease swallowing and
minimize aspiration.
 Monitor for signs & symptoms of
aspiration that indicate swallowing
dysfunction.
 Monitor body weight to determine need

52. 4.Improve Body Image
 Assess patient’s feelings about
tracheostomy.
 Approach patient with an accepting
attitude.
 Allow patient opportunity to verbalize
concerns about tracheostomy.
 Refer patient to support group if
available.
 Assist patient in finding attractive ways
to conceal tracheostomy if desired.

53. 5.Infection Control
 Assess & observe –stoma erythema ,odor,
irritation inflammation ,pus.
 Assess vita sign.
 Use good hand-washing practice.
 Monitor and report sign & symptoms of
infection; fever, increased respiration rate,
purulent sputum ,elevated WBC count.

54. 5.Infection Control
 Maintain sterile technique when
suctioning and providing tracheostomy
care to reduce occurrence of infection.
 Provide trachea care every 4 to 8 hrs. as
appropriate: clean inner cannula, clean &
dry the area around the stoma, & change
tracheostomy ties.
 Protect tracheostomy opening from
foreign material; food, sprays, powders.

55. Teaching on tracheostomy care
& disease process
 Demonstrate skill for patient.
 Give clear ,step-step directions so patient
can care for self at home.
 Provide practice sessions
 Provide frequent feedback to patient on
what the/she is doing correctly and
incorrectly so pt. can care for self at home.
 Provide written information/diagrams for
reference
 Observe patient return demonstration skill
to assess skill level & need for additional
teaching.

56. Contd…
Teaching :Disease process
 Identify possible etiologies so patient
understands rationale for tracheostomy.
 Describe the disease process to allow patient
to plan treatment routine.
 Instruct the patient on which signs and
symptoms (eg. change in secretion-blood
tinged/elevated body temperature) to report to
health care provider.

57. Contd…
 Refer patient to local community
agencies/support groups to provide
ongoing assistance and support.

58. References
Lewis, l. S., Heitkemper, M. M., Dirksen, R. S., & O'Brien, G. P. (2005).
Medical Surgical Nursing-Assessment and Management of Clinical
Problems (7 ed.). New Delhi: Elsevier.
Williams, S. L., & Hopper, D. P. (2003). Medical Surgical Nursing (2
ed.). Philadelphia: F.A.Davis Company.
Efi, E., & Ekaterini, L. (2010). Tracheostomy and Nursing care (Vol.
11).Retrievedfrom
http://web.b.ebscohost.com/abstract?direct=true&profile=ehost&scope
=site&authtype=crawler&jrnl=14500795&AN=66447711&h=utXO1e
RjIT7BsJ5