What is Tracheostomy Care Procedure and how it Works?

Tracheostomy is a proven medical procedure that involves the creation of a hole in the neck for the purpose of placing a tube in the patient’s windpipe. This particular tube is inserted through an operated opening in the neck down the vocal cords. This arrangement allows the air to enter into the lungs. Thus, breathing is done with the help of this artificial tube. Tracheostomy is commonly known as a stoma. A stoma is a hole near the neck through which the tube is passed through to reach the windpipe.

Reasons for performing Tracheostomy

Tracheostomy is being performed due to several reasons which all involve restricted airflow. This procedure can be executed at the time of emergency when the airway is usually blocked. This medical procedure can also be performed when the patient faces breathing issues due to some prolonged disease or due to some accident. Some of the common conditions that usually require tracheostomy include the following:

• Anaphylaxis
• Burns in the airway due to inhalation of any corrosive material
• Chronic disease of the lungs
• Lung cancer
• Coma
• Respiratory infection
• Dysfunction of the diaphragm
• Chest wall injury
• Injury to the larynx.
• Condition of prolonged ventilator or respiratory support
• Airway obstruction due to a foreign body’s entry
• Sleep apnea
• Severe mouth or neck injuries
• Muscles’ paralysis
• Tumors
• Paralysis of the vocal cord

Preparation for Tracheostomy

In case there is no emergency situation and if it is a planned tracheostomy, then your doctor usually tells you to get prepared for this procedure and provides the necessary guidance that is required for the same. This usually involves fasting for a maximum of twelve hours prior to the initiation of the procedure. In case tracheostomy is being performed in an emergency situation, then there is usually no time for preparation.

Tracheostomy care procedure

The post tracheostomy care procedure can be divided into three major sections.

Section 1

Initial care- Care required for the new Tracheostomy which is less than 7 days old

Specialized nursing care is highly required within the very first seven days following the tracheostomy procedure. There can be several complications which can be avoided by imparting initial care. The early post insertion complications include the following:
Accidental decannulation or tube displacement

• Pneumothorax
• Hemorrhage
• Tube blockage
• Surgical emphysema
• Infection in the chest or stoma site
• Humidification
• Feeding

So, the specialized care for tracheostomy should have the capacity of handling all such complications.

Section 2

Management of ‘TRACHE’ bundle
There is a specialized multi-disciplinary management of ‘TRACHE’ bundle.

• T= Tapes: Meant to secure the tracheostomy procedure- A tube used in the medical procedure of tracheostomy is held in proper place using cotton tapes surrounding the neck. The placed tracheostomy tube is to be completely secured and is crucial in the maintenance of the airway safety. This becomes a major challenge, especially in the case of pediatric patients. The studies have shown that the neck tapes made out of Velcro are prone to be more susceptible to be undone by the patients or they have the tendency of attaching to the clothing. Thus, there are higher chances of decannulation that happens accidentally when Velcro neck tapes are being used. Thus, as per the departmental policies now the exclusive use of the cotton tapes that are hand-tied is being used in order to keep the tracheostomy tubes secure. Changing of the tapes also require special expertise and this is a two-person procedure.
• R= Resus: Knowing the process of resuscitation- The Basic Life Support (BLS) which is used in emergency care are airway management, circulatory support, and rescue breathing. The airway element requires modification in case of pediatric patients.
• A= Airway: Suctioning- The significance of precise suctioning cannot be underestimated under any circumstances. In case the length of the suction is too short, the patient might run a risk of tube blockage. On the contrary, in case the length of the suction is too long; there are chances of causing tracheal trauma which may eventually result in distal soft tissue trauma and overgrowth. The practitioners who provide care to such patients should be very competent in respiratory assessments. They ought to be proactive in determining the indications for suctioning and suction techniques have to be well-implemented by them in order to minimize the probable complications and maximize the effect of the treatment. The potential complications include the formation of distal granulation, hypoxia, pneumothorax, cardiovascular changes, bacterial infection, atelectasis and intracranial changes.
• C= Care of the site, neck, and stoma- The most recommended practice is to review the stoma and also to access the skin near the stoma every day. This is to be mandatorily recorded in the patient’s healthcare record.
• H= Humidity: Necessity to keep the tube absolutely clear- The nasopharynx space naturally provides an optimum environment where the inspired air is maintained at a temperature of 37 degrees Celsius and 100% humidity. The Tracheostomy tube is placed in such a way that it bypasses this space and sometimes run out of the optimum condition, The natural warming, filtering of the air and the humidification usually happens in the upper airway but sometimes run out of the optimum condition. Thus, the optimum conditions have to be artificially achieved by the caregivers. Artificial humidification is implemented in order to avoid the blockage of the tube.
• E=Emergency Box- The contents of the emergency tracheostomy box are being designed in order to include the absolute essential equipment that is required for accidental decannulation or in case of an emergency tube change.

Section 3

Discharge Planning and Carer Competency Guide

The staff are trained and assessed in some key competencies in the following sub-segments:

• Tracheostomy Care at Home
• Staff Competencies for ventilation
• Emergency handling

The carer should be chosen as per the condition of the patient. Also, this is to be kept in mind that the correct emergency equipment and a dedicated area with all necessary equipment are to be availed in order to facilitate optimum tracheostomy care nursing.