Transcript
Tracheostomies are openings into the trachea through the neck where an indwelling tube is placed to create an artificial airway. These are used for patients who need long-term airway support. Tracheostomy tubes have outer cannulas that are inserted into tracheas and a part of them rests against then neck and allows tubes to be secured in place with tape or ties. Care for tracheostomies is provided by nurses to ensure the patency of the tube and reduce the risk of infection (Engels et al., 2009). At the beginning, tracheostomies may need to be suctioned and cleaned as often as every 1 to 2 hours.
Each hospital facility will have its own policies and procedures in regard to caring for patients with tracheostomy due to the changing of the cannula and assessing the cuff inflation. This can vary from institution to institution. When performing tracheostomy care, the nurse should assess the tracheostomy for inflammation, redness, edema, and other signs of infection. The stoma should be assessed and then cleaned with normal saline with a sterile dressing placed around the tube site (Lewis et al., 2017, p. 487). About every 8 hours, the pressure of the cuff should be monitored and assessed. The cuff pressure should not exceed 20 to 25 cm H2O. If the pressure exceeds this, the blood capillaries can become compressed, hindering blood flow. Along with this basic care, tracheostomies may need to be suctioned as needed. The tracheostomy bypasses the upper respiratory tract resulting in the air losing its chance to become humidified.
When and if the tracheostomy becomes dislodged, the nurse should readily have a tube of equal size and one of smaller size by the bedside. This will prevent the airway from being compromised for too long by having access to a new tube readily available.
References
Engels, P. T., Bagshaw, S. M., Meier, M., & Brindley, P. G. (2009). Tracheostomy: from insertion to decannulation. Canadian journal of surgery. Journal canadien de chirurgie, 52(5), 427–433.
Lewis, S. L., Bucher, L., McLean Heitkemper, M., Harding, M. M., Kwong, J., Roberts, D., (2017). Medical-surgical nursing: Assessment and management of clinical problems (10th ed.). St. Louis, Mo: Elsevier.
