tracheostomy care


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tracheostomy care

Etymology: Gk, tracheia, rough artery, stoma, mouth
care of the tracheostomy patient, consisting of maintenance of a patent airway, adequate humidification, aseptic wound care, and sterile tracheal aspiration. Complications can include injury to the vocal cords, gastric distension and regurgitation, occlusion of the endotracheal tube, and an increased risk of infection.

tracheostomy care

Management of the tracheostomy wound and the airway device. The patient should be suctioned as often as necessary to remove secretions. Sterile technique is maintained throughout the procedure. Before suctioning, the patient should be aerated well, which can be accomplished by using an Ambu bag attached to a source of oxygen. The patency of the suction catheter is tested by aspirating sterile normal saline through it. The catheter is inserted without applying suction, until the patient coughs. Suction is then applied intermittently and the catheter withdrawn in a rotating motion. The lungs are auscultated by assessing the airway, and the suctioning procedure is repeated until the airway is clear. Each suctioning episode should take no longer than 15 sec, and the patient should be allowed to rest and breathe between suctioning episodes. The suction catheter is cleansed with sterile normal saline solution, as is the oral cavity if necessary. The inner cannula should be cleansed or replaced after each aspiration. Metal cannulas should be cleansed with sterile water.

An emergency tracheotomy kit is kept at the bedside at all times. A Kelly clamp is also kept at the bedside to hold open the tracheostomy site in an emergency. Unless ordered otherwise, cuffed tracheostomy tubes must be inflated if the patient is receiving positive-pressure ventilation. In other cases, the cuff is kept deflated if the patient has problems with aspiration. The dressing and tape are changed every 8 hr, using aseptic technique. Skin breakdown is prevented by covering tracheostomies with an oval dressing between the airway device and the skin. To apply neck tapes, two lengths of twill tape approx. 10 in (25 cm) long are obtained; the end of each is folded and a slit is made 0.5 in (1.3 cm) long about 1 in (2.5 cm) from the fold. The slit end is slipped under the neck plate and the other end of the tape pulled through the slit. This is repeated for the other side. The tape is wrapped around the neck and secured with a square knot on the side. Neck tapes should be left in place until new tapes are attached. Tracheal secretions are cultured as ordered; their color, viscosity, amount, and abnormal odor, if any, are observed. The site is inspected daily for bleeding, hematoma formation, subcutaneous emphysema, and signs of infection. Appropriate skin care is provided. The medical care team should help alleviate the patient's anxiety and apprehension and communicate openly with the patient. The patient's response is documented.

See: Suctioning: Tracheostomy, Portable Open System
See also: care
References in periodicals archive ?
Bayshore Residence and Rehabilitation has also invested in new training and equipment to better accommodate patients requiring specialized complex care, such as bariatric patients, wound care, and tracheostomy care.
Each center is also able to offer amputee therapy and training, bariatric rehabilitation, cardiac therapy, hip repair and joint replacement recovery, IV antibiotic therapy, pain management services, palliative care, post-surgery orthopedic care, respiratory therapy and management, tracheostomy care, wound care and wound VAC.
Patients with subacute health needs can also benefit from the tracheostomy care, respiratory management, wound care, IV antibiotic therapy, enteral nutrition therapy, and comfort and palliative care that the center offers.
Additional classes are also offered to our home health care nursing staff,which includes a variety of topicssuch as tracheostomy care, ventilator support, and wound vacuum equipment training.