Speaker : ZayChung

Venue: Coronary Care Department

Time : 0730-0830hrs

Date : 2008

1. Nurses Aware of the management of patient with tracheostomy

2. Prevent Complication

1. A Tracheostomy is a Surgical incision made between the second and third tracheal rings.

2. Then a cuffed tracheostomy tube of an appropriate size is inserted, for the purpose of establishing an airway

1. Bypass an Upper Airway Obstruction

2. Facilitate removal of secretion

3. Permit long-term mechanical ventilation

4. Permit oral intake and speech in the patient who requires long-term mechanical ventilation

1.Temporary: **Elective Procedure E.g.: Followed by major surgery like partial glossectomy2. Permanent: **Tracheostomy follow a total laryngectomy or unable to wean off intubations3. Emergency: **Perform as an emergency when patient has

an obstruction airway condition E.g:Poisoning (Corrosives)

1. Portex Cuffed Tracheostomy Tube

- available with inner / without inner cannula

- plastic

- inflatable cuff

- give airtight seal

2 . Shiley Plain Tracheostomy Tube

- plastic

- comes with introducer and 2 inner tubes

- facilitates connection to other equipment

E.g.: Speaking Valves

3 . Shiley Fenestrated Tube

- plastic

- with introducer

- two inner tube – one with extension

4 . Shiley Cuffed Fenestrated Tube

- plastic

- with introducer

- two inner tube

Sterile technique is to be followed throughout

Procedure• Gather Supplies• Explain procedure• Wash hand• Prepare equipment• Put on sterile gloves• Remove sterile suction catheter from package

7. Lubricate tip of catheter by dipping tip in sterile saline8. Pre-Oxygenate patient prior suctioning9. Disconnect from the supplementary oxygen source10. If patient is cooperative, ask him / her to take deep breath and quickly but gently insert the catheter into the trachea. If resistance is felt withdraw the catheter slightly. (The catheter control valve is left open or not depressed during insertion, so that no suction is applied during insertion)

11. Apply intermittent suction.

Rotate the catheter between your thumb

forefinger during withdrawal of catheter

12. As soon as the catheter withdrawn ,

re-connect to the ventilator or oxygen

supply source.

Re-oxygenate the patient

13. Clear the Catheter with saline

14. Repeat the procedure if necessary

Note:

The Suction procedure should not take any

Longer that 15sec from insertion to completion

Of withdrawals of catheter.

Supplies

1. Sterile dressing pack

2. Tracheostomy dressing / keyhole

3. Solution (Saline)

4. Tracheostomy tape / tie

1. Explain to patient the procedure2. Privacy (Screen the area / Bed)3. Wash hand4. Perform the procedure under aseptic technique5. Remove the soiled dressing6. Clean trache stoma area with saline7. Replaced with tracheostomy

dressing/keyhole8. Re-new the tracheostomy tapes/tie (Checked that one finger can be placed

between the tapes/tie and neck)

• Small brush or pipe

cleaners• Half strength

solution

of hydrogen peroxide

• Saline 0.9%• Two small Bowl

(Kidney basin)

1. Wash hand2. Place ½ strength hydrogen peroxide in one bowl and sterile saline in 2nd bowl3. Remove the inner cannula while holding the next plate of the trach still..4. Place the inner cannula in peroxide

solution and sock until crusts are soften or removed5. Use the brush or pipe cleaner to clean the

inside, outside and creases of the tube6. Look inside the inner cannula to make sure

it is clean and clear of mucus

7. Rinse tube in saline water

8. Reinsert it while holding the neck plate of the trach still..

9. Turn the inner cannula until it locks into position

10.Double check the locking by pulling forward gently on the inner cannula

11.Kept the clean trach tube in a proper place.

1. Infection

2. Dysphagia

3. Obstruction from accumulation of secretions

4. Aspiration

5. Tracheal dilation, ischemia & Necrosis

• Bleeding• Pneumothorax• Air Embolism• Subcutaneous or Mediastinal emphysema• Recurrent laryngeal nerve damage• Posterior tracheal wall penetration• Rupture of the innominate artery• Tracheoesophageal fistula

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