Feb
24
2011

Use and Care of Tracheostomies

Intubation is the process of inserting an artificial airway. Usually plastic, disposable airways are used. They come in adult, pediatric, and infant sizes.

Tracheostomy tube is inserted through a surgical incision (ostomy) into the trachea. Some tracheostomy tubes have cuffs. The cuff is inflated to keep the tube in place. This is done by a doctor. Nursing assistants assist the nurse in caring for persons with artificial airways. The person’s vital signs are checked often. The person is observed for hypoxia and other respiratory signs and symptoms.

-If an airway comes out or is dislodged, tell the nurse immediately.
-the person needs frequent oral hygiene. The nurse tells you when and how to perform oral hygiene.
-talking is hard with oropharyngeal and nasopharyngeal airways.
-persons with endotracheal tubes can not speak.
-some tracheostomy tubes allow the person to speak.
-paper and pencils, magic slates, communication boards, and hand signals are ways to communicate.
-gagging and choking sensations are common with artificial airways.
-use touch to show you care.

Tracheostomies are temporary or permanent. Temporary when the person requires mechanical ventilation. Permanent when airway structures are surgically removed. (Cancer and some severe trauma injures the airway)

Tracheostomy tubes are made of plastic or metal. It has three parts: the outer tube, the inner tube and the obturator.

-Inner and outer tubes are often called the inner and outer cannulas.
-the obturator has a rounded end. It is used to insert the outer cannula. After the outer cannula is inserted, the obturator is removed. (The obturator is placed within reach in case the tracheostomy tube falls out and needs to be reinserted. It is taped to the wall or bedside stand.)
-the inner cannula is inserted and locked in place. The outer cannula is secured in place with ties around the person’s neck or a Velcro collar.
-the inner cannula is removed for cleaning and mucus removal. This keep the airway patent (open). The outer cannula is not removed.
-some plastic tracheostomy tubes do not have inner cannulas. These are used for persons who are suctioned often. With frequent suctioning mucus does not stick to the cannulas.
-the cuffed tracheostomy tube provides a seal between the cannula and the trachea. This type is used with mechanical ventilation. The cuffs prevent air from leaking around the tube. It also pevents aspiration. A nurse or respiratory therapist inflates or deflates the cuff.
-securing tracheostomy tubes in place is important. The tube must not come out (extubation). If not secured properly, the tube could come out with coughing or if pulled on. Damage to the airway is possible if the tube is loose and moves up and down in the trachea.
-the tracheostomy tube must remain patent. Some persons can cough secretions up and out of the tracheostomy. Others require suctioning.
-call the nurse if the person shows signs and symptoms of hypoxia or respiratory distress. Also call the nurse if the outer cannula comes out.
-measures are needed to prevent aspiration. Nothing can enter the stoma. Otherwise the person can aspirate.

The Nurse teaches the person and family the following:

1. Make sure dressings do not have loose gauze or lint.
2. Keep the stoma or tube covered when outside. Wear a stoma cover, scarf, or shirt or blouse that buttons at the neck. The cover prevents dust, insects, and other smaller particles from entering the stoma.
3. Take tub baths instead of showers. If showers are taken, wear a shower guard and use a hand held nozzle. Direct water away from the stoma.
4. Be careful when shampooing. Ask another person to help you.
5. Cover the stoma when shaving.
6. Do not swim, water will enter the tube or stoma.
7. Wear a medical alert bracelet, also carry a medical alert ID card

Tracheostomy Care – involves cleaning the inner cannula, cleaning the stoma, and applying clean ties or Velcro collar. Cleaning the cannula removes mucus. This keeps the airway patent. A clean stoma and a clean ties or collar help prevents infection at the tracheostomy site. Cleaning the stoma also help prevent skin breakdown.
– some inner cannulas are disposable. They are used once and then discarded. The inner cannula is not cleaned a new one is inserted.
-the nurse may ask you to assist with tracheostomy care. It may be done daily or every 8-12 hours. Tracheostomy care is done when there are excess secretions, the ties or collar is soiled, or the dressing is soiled or moist. When the ties are removed, you must hold the outer cannula in placed. The ties or collar must be secure but not tight. A finger should slide under the ties or collar. Standard precautions and bloodborne pathogen standard are followed when assisting the nurse.
for children, only fingertip is inserted under the ties. Ties are too loose if you slide your whole finger under them. When assisting with tracheostomy care, you must hold the child still. Position the child’s head so that the neck is slightly extended.

Nicetas

About the Author: Nicetas Juanillo

Writing makes me happy away from home. My website is where you can find my tips about lifestyle, health and other issues. I also have books on my site that you can read to know more

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