Care of a Tracheostomy on the ward

Tracheostomy:

The Tracheostomy tube passes through the trachea into the main bronchus and sits above the carina. Around the end of this tube is an inflatable cuff which prevents aspiration. Once the risk of aspiration has been reduced and the patient can cough well enough the cuff may be deflated, or a non-cuffed +/- fenestrated tube inserted.

 

Oxygen supply:

Tracheostomies block easily and must always be humidified using a aquapack and a heater. This also stops the lungs natural mucus barrier from dehydrating. If no oxygen, humidification must always be supplied.

 

Maintaining the patency of the tube:

Secretions build up regularly so to stop blockage suction must be carried out every 2—4 hours. Encourage the patient to take some deep breathes before and after suction to improve the removal of secretions, so keeping the chest clear.

 

Suction:

Sterile techniques should be employed and the use of a size 12 catheter. Once the catheter has advanced approximately half way the carina has probably been reached and a cough should be elicited then suction applied.

 

Emergency:

If the tube remains blocked after suction or no cough is elicited during aspiration then syringe down about 5mls of saline over the blockage and quill directly over the blockage and suction immediately. If this does not relieve the blockage then deflate the cuff to allow the patient to breathe.

Tracheostomy Tubes

Aim: to preserve/ protect airway, may be part of another procedure electively or as an emergency.

Risks: bleeding, infection, scarring, altered voice, difficulty swallowing, psychological morbidity.