UNIVERSITY FOR DEVELOPMENT

STUDIES
SCHOOL OF ALLIED HEALTH
SCIENCES
NURSING DEPARTMENT
COURSE: ADVANCE NURSING I
COURSE CODE: NUR 206
LECTURER: MS MILLICENT AARAH-BAPUAH
PRESENTATION ON TRACHEOSTOMY BY GROUP SIX
 TRACHEOSTOMY
• A tracheostomy is a surgical procedure in which an opening is
made into the trachea and an indwelling tube inserted. A
tracheostomy is used to bypass an upper airway obstruction,
to allow removal of tracheobronchial secretions, to permit the
long-term use of mechanical ventilation, to prevent aspiration
of oral or gastric secretions in the unconscious or paralyzed
patient (by closing off the trachea from the esophagus), and
to replace an endotracheal tube.
• TRACHEOSTOMY TUBE
• A tracheostomy (trach) tube is a small tube inserted into the
tracheostomy to keep the stoma (opening) clear.
Tracheostomy tubes are available in several sizes and
materials including semi-flexible plastic, rigid plastic or metal.
The tubes are disposable or reusable. They may have an inner
cannula that is either disposable or reusable. The
tracheostomy tube may or may not have a cuff. Cuffed trach
tubes are generally used for patients who have swallowing
difficulties or who are receiving mechanical ventilation. Non-
cuffed trach tubes are used to maintain the patient’s airway
when a ventilator is not needed. The choice of tube is based
on the condition of the patient, neck shape and size and
purpose of the tracheostomy.
• All trach tubes have an outer cannula (main shaft) and a neck-
plate (flange). The flange rests on the neck over the stoma
(opening). Holes on each side of the neck-plate allow you to
insert trach tube ties to secure the trach tube in place.
• TYPES OF TRACHEOSTOMY
A tracheostomy can either be
• Temporary tracheostomy or
• Permanent tracheostomy

• INDICATIONS OF TRACHEOSTOMY
• Obstruction of the throat
• Breathing difficulty caused by edema (swelling).
• Airway reconstruction following tracheal or laryngeal
surgery
• Airway protection after head and neck surgery
• Long-term need for mechanical ventilation support
• CONTRAINDICATIONS
• No absolute contraindications exist for tracheostomy, but
laryngeal carcinoma can be of blockage factor to the
procedure of tracheostomy. Also pediatrics can also be a
potential contraindication.

• PRE OPERATIVE PREPARATION

• Assessment:
• Obtain a complete set of vital signs
• Assess patient’s understanding of the surgical procedure
• Obtain detailed past medical and surgical history
• Physical preparation
• Assist the patient with personal hygiene and
related care: bath, mouth care, etc.
• Help the patient to change into a clean hospital
gown
• Physiological preparation
• Nil per Os
• Administer prescribed IV fluids
• Administer blood transfusions if required and
prescribed Medications
• Psychological preparation
• Assess patient for the presence and intensity
of fear and anxiety
• Identify sources of fear and anxiety and clarify
any misconceptions about surgery
• Ask the patient about spiritual needs
• Reassure patients
• Legal preparation
• Signing of consent on patient own willing.

• Patient teachings
• Teach patient:
• Deep breathing and coughing exercises
• Relatives’ role in the immediate postoperative period
• Any special positioning postoperatively
• Postoperative exercises
• Use of a pain intensity rating scale
• PROCEDURE/STEPS
• The surgical procedure is usually performed in the
operating room or in an intensive care unit, where the
patient’s ventilation can be well controlled and optimal
aseptic technique can be maintained
• The patient is supine with head extension and
exposure of the trachea, under general/local
anaesthesia.
• The incision area is cleaned with a non-alcoholic
antiseptic.
• Incision is 2-3 cm from the second tracheal ring down.
• Divide the thyroid isthmus if needed.
• Make a hole between the third and fourth tracheal
rings, removing the anterior portion of tracheal ring.
• After the trachea is exposed, a cuffed or non cuffed
tracheostomy tube of an appropriate size is inserted
base on the patient condition.
• The tracheostomy tube is held in place by tapes
fastened around the patient’s neck.
• Usually a square of sterile gauze is placed between the
tube and the skin to absorb drainage and reduce the
risk for infection
 POST OPERATIVE CARE OF
TRACHEOSTOMY
• TRACHEOSTOMY CARE:
• Requirements:
• Sterile gloves
• Hydrogen peroxide
• Normal saline solution or sterile water
• Cotton-tipped applicators
• Dressing
• Twill tape
• Type of tube prescribed, if the tube is to be
changed
• Actions:
• Perform hand hygiene.

• Explain procedure to patient and family as appropriate and

provide privacy

• Put on clean gloves; remove and discard the soiled dressing

in a biohazard container.

• Prepare sterile supplies, including hydrogen peroxide,

normal saline solution or sterile water, cotton-tipped
applicators, dressing, and tape.
• Put on sterile gloves that’s after washing hand when
dirty or soiled things are disposed .

• Cleanse the wound and the plate of the tracheostomy

tube with sterile cotton-tipped applicators moistened
with hydrogen peroxide. Rinse with sterile saline
solution.
• Soak inner cannula in peroxide or sterile saline, per
manufacturer’s instructions; rinse with saline solution;
and inspect to be sure all dried secretions have been
removed. Dry and reinsert inner cannula or replace
with a new disposable inner cannula
• Place clean twill tape in position to secure the tracheostomy tube
by inserting one end of the tape through the side opening of the
outer cannula. Take the tape around the back of the patient’s neck
and thread it through the opposite opening of the outer cannula.

• Remove old tapes and discard in a biohazard container after the

new tape is in place.

• Although some long-term tracheostomies with healed stomas may

not require a dressing, other tracheostomies do. In such cases, use
a sterile tracheostomy dressing, fitting it securely under the twill
tapes and flange of tracheostomy tube so that the incision is
covered
• SUCTIONING OF THE TRACHEOSTOMY TUBE
• Materials needed:
– Suction catheters
– Gloves (sterile and non-sterile), gown, mask, and
goggles for eye protection
– Basin for sterile normal saline solution for irrigation
– Manual resuscitation bag with supplemental oxygen
– Suction source
• Implementation
• Assess the patient’s lung sounds and oxygen saturation via
pulse oximeter.
• Explain the procedure to the patient before beginning and
offer reassurance during suctioning.
• Perform hand hygiene. Put on non-sterile gloves, goggles,
gown, and mask.
• Turn on suction source (pressure should not exceed 120
mm Hg).
• Open suction catheter kit.
• Fill basin with sterile water.
• Put sterile glove on dominant hand
• Ventilate the patient with manual resuscitation bag and
high-flow oxygen for about 30 seconds or turn on suction
mode of ventilator (if available) to hyper oxygenate the
patient. Instill normal saline solution into airway only if
there are thick, tenacious secretions.
• Pick up suction catheter in sterile gloved hand and connect
to suction.
• Insert suction catheter at least as far as the end of the tube
without applying suction, just far enough to stimulate the
cough reflex.
• Apply suction while withdrawing and gently rotating the
catheter 360 degrees (no longer than 10 to 15 seconds).
• Reoxygenate and inflate the patient’s lungs for several
breaths with manual resuscitation bag, or allow ventilator
to reoxygenate patient for several breaths using suction
mode.
• Rinse catheter by suctioning a few milliliters of sterile saline
solution from the basin between suction attempts.
• Rinse suction tubing and discard catheter, gloves, and basin
appropriately.
• Assess the patient’s lung sounds and oxygen saturation via
pulse oximeter after procedure.
• Document the amount, color, and consistency of
secretions.
• STOMA CARE
• Meticulous care towards hygiene and asepsis is necessary.
• Remember that the skin surrounding the stoma is also prone to irritation.
• The area should be cleaned with normal saline and barrier cream applied
to the local skin.
•
• CARE DURING ACCIDENTAL EXPULSION OF MAIN TUBE
• Keep the tracheal stoma opened with a tracheal dilator
• Call for assistance, reassure patient, organize a spare tube for insertion,
insert the tube and give oxygen immediately.
• Check vital signs in at least 15 minutes, cyanosis, presence of respiratory
distress and mental confusion.
• Suction the tube and the orophageal passages .investigate the cause of
the dislodgement, document and report.
• COMPLICATIONS
• Complications may occur early or late in the course of tracheostomy
management. They may even occur years after the tube has been
removed

• IMMEDIATE POSTOPERATIVE COMPLICATIONS:

• Bleeding,
• Pneumothorax,
• Air embolism,
• Aspiration,
• Subcutaneous or mediastinal emphysema,
• Recurrent laryngeal nerve damage and posterior tracheal wall
penetration
• LONG-TERM COMPLICATIONS INCLUDE
• Airway obstruction from accumulation of
secretions,
• Infection,
• Rupture of the innominate artery,
• Dysphagia,
• Tracheoesophageal fistula,
• Tracheal dilation,
• Tracheal ischemia and necrosis
 ADDITIONAL INFORMATION

• ISSUES WITH EATING

• At the initial stage of the procedure a patient
receives nutrients through an intravenous line
inserted into the vein. A feeding tube can also be
passed through the patient mouth or directly
inside the stomach for food to be given. A speech
therapist would come in place if a patient is
recovering to eat my mouth. The speech therapist
would teach the patient how to controls the
muscles and coordination needed for swallowing.
 REFERENCES

• Sanjita K, et al. Fundamental of Nursing

Procedure Manual (2008). Japan International
CooperationAgency (JICA),Nepal Office.
• https://emedicine.medscape.com/article/865068
-overview
• https://my.clevelandclinic.org/health/treatments
/17568-tracheostomy-care
• Brunner ,L.S.,Suddarth,D.S., Smeltzer,S.C.O., &
Bare, B.G (2010). Brunner & Suddarth’s textbook
of medical-surgical nursing (12th edition).