Transcript Slide 1
TRACHEOSTOMY CARE
BILL WOJCIECHOWSKI, MS, RRT
DEPARTMENT OF CARDIORESPIRATORY CARE
UNIVERSITY OF SOUTH ALABAMA
MOBILE, ALABAMA
TRACHEOSTOMY CARE
Upper airway
functions
bypassed when
patient has
tracheotomy
performed.
UPPER AIRWAY FUNCTIONS
Heat/moisture
exchange
Thermoregulation
Gustation (taste)
Olfaction (smell)
Filtration
CLINICAL COMPLICATIONS
Altered or loss of voice
Speech & language delays (young children)
Loss of smell & taste
Compromised nutritional status
Impaired swallowing/increased risk of
aspiration
Secretion control issues/infection
Psychological distress
Loss of physiologic PEEP
CLINICAL COMPLICATIONS
Absence of airflow often creates
Frustration
Anxiety
Psychological
distress
For children: delayed
speech & language
development
CLINICAL COMPLICATIONS
Absence of airflow decreases sensations
Smell
Taste
Poor
appetite
Skin health
Supplemental
feeding
Difficulty swallowing
Risk of aspiration
CLINICAL COMPLICATIONS
Cuffed trach tubes anchor larynx & sometimes
interfere with:
Laryngeal
elevation
Epiglottic inversion
Airway protection
Cuffed trach tubes
secure larynx,
Deflated cuff: more
freedom.
Three phases of normal swallowing:
1) Oral phase
2) Pharyngeal phase
3) Esophageal phase
UPPER AIRWAY FUNCTIONS
Normal swallowing (pharyngeal phase):
Oral
& nasal cavities sealed
Vocal cords close
Positive pressure generated below cords
Air prevented from entering larynx
Larynx elevates & moves forward
Acts as a lever (mechanical event)
Epiglottis seals larynx
Food/liquid directed into esophagus
UPPER AIRWAY FUNCTIONS
Swallowing with Trach Tube Inserted:
Vocal cords close
Air flows through trach tube
No subglottic
positive pressure
Reduced sensations in
larynx & pharynx
Pooling of airway secretions
Increase risk of aspiration
Most patients OK!!
CLINICAL COMPLICATIONS
Absence of upper airway airflow (inability to
nose-breathe) compromises:
Heat/moisture
exchange
Increased secretion viscosity
Increased secretion volume
Frequent suctioning
Increase risk of airway trauma/infection
Presence of trach tube stimulates secretions
http://www.brucemedical.com/filandcov.html
CLINICAL COMPLICATIONS
With cuff inflated:
No
physiologic PEEP
Possible
micro-atelectasis
Decreased
alveolar ventilation
Compromised
oxygenation
Cuff deflated
Physiologic
PEEP
Present
Cuff inflated
Physiologic
PEEP
Absent
TRACHEOSTOMY CARE
Inspect stoma daily: irritation/inflammation.
Tracheostomy care is done every 8 to 12 hours
and PRN.
Avoid dressings trapping moisture.
Check secretions: white & clear; greenish-yellow
Odor often indicates infection.
Assess need for suctioning q2h.
TRACHEOSTOMY CARE
Signs of Infection:
Yellow
or green secretions (pink or blood-tinged)
Thicker mucus
Greater volume of mucus
Stoma site bleeding
Foul odor from stoma
Febrile patient
Pulmonary congestion
Increased RR
Listlessness
Discomfort with trach/tender stoma site
CLEANING INNER CANNULA
PROCEDURE
CLEAN INNER CANNULA
1. Loosen inner cannula.
2. Hold outer cannula with
one hand. Turn
inner cannula to right
with other hand to
unlock.
CLEAN INNER CANNULA
3. Remove the inner
cannula by
steadily pulling it down
and toward
your chest until it is out.
CLEAN INNER CANNULA
4. Place inner cannula in
the solution of hydrogen
peroxide & normal
saline, and don sterile
gloves.
CLEAN INNER CANNULA
5. Use trach brush, or pipe
cleaner, to clean inner
cannula of mucus and
dried secretions.
CLEAN INNER CANNULA
6. Place it in bowl of
normal saline (NS).
7. Shake off excess NS.
Moisture will act as
lubricant during inner
cannula reinsertion.
CLEAN INNER CANNULA
8. Reinsert inner cannula,
keeping curved portion
facing downward.
CLEAN INNER CANNULA
9. Lock inner cannula into
position.
10. Wash bowls
thoroughly and allow to
air dry. Soak trach
brush soak in hydrogen
peroxide-NS solution &,
rinse with NS. Air to dry.
Discard pipe cleaners.
CUFF PRESSURE
Goal: maintain cuff pressure below tracheal
mucosal capillary perfusion pressure which
is: 25 to 30 mm Hg.
Cuff pressure maintained: 20 to 25 mm Hg, or
25 to 35 cm H2O
Higher cuff pressures
Cut off tracheal mucosal blood flow
Tracheal wall damage (necrosis/tracheomalcia)
CPR - TRACHEOSTOMY
Caregivers must receive CPR training.
Suction if indicated.
Change trach tube if clogged.
Spare
tubes (cuffless &/or cuffed): same size & 1
size smaller
Pinch nose & mouth (cuffless trach).
2 breaths with manual resuscitator/mouth-totrach/mouth-to-stoma: STOMA LEAK
Mouth-to-mouth/bag-mask with finger over
stoma: STOMA LEAK
TRACHEOSTOMY & SPEECH
Fenestrated:
Weaning
Speech
Granuloma formation
Increased risk of
aspiration
TRACHEOSTOMY & SPEECH
Some space
around tube
Snug fit:
tube too large
non-fenestrated:
poor or no speech
TRACHEOSTOMY & SPEECH
TRACHEOSTOMY TUBE PRECAUTIONS
Use extreme caution with baths and water
No swimming
Avoid powder, talc, chlorine bleach, ammonia,
aerosol sprays, or colognes and perfumes
Prevent foreign objects from entering trach
tube
TRACHEOSTOMY TUBE PRECAUTIONS
Avoid dust
Avoid sand and beach
Watch play with other children to assure toys,
fingers or other foreign bodies are not put into
trach and trach is not pulled
No contact sports
Frequent hand washing
EDUCATION
Teach airway anatomy
Teach about equipment
Teach CPR
Teach infection control
Teach humidification
Teach suctioning
Teach about speaking valves/fenestrated
trach tubes
Teach communication through speech therapy