TRACHEOSTOMY CARE PROGRAM

What is Traceohosotomy?

Tracheostomy is a medical procedure which involves creating an opening (stoma) in the neck in order to place a tube into a person’s windpipe (Trachea).

A specially designed tracheostomy tube is inserted through the opening in the neck below the vocal cords which allows air to enter the lungs bypassing the nasal and oral passage. It also helps in clearing the secretions from the airway.

When and who will need Tracheostomy?

Three main reasons for tracheostomy are:

  1. to bypass an obstructed upper airway;
  2. to clean and eliminate secretions from the airway;
  3. to deliver more oxygen safely and easily to the lungs.

All tracheostomies are performed due to an insufficient amount of air getting to the lungs. There are many reasons why adequate air cannot get to the lungs.

Why Tracheostomy is done?

Situations that may call for a tracheostomy include:

  • Any medical condition that necessitates the use of a breathing machine (ventilator) for a prolonged period, usually more than one or two weeks.
  • Medical issues that block your airway, such as vocal cord paralysis or throat cancer
  • Paralysis, neurological problems or other conditions that make it difficult to cough up secretions from throat and require direct suctioning of the windpipe (trachea) to clear your airway.
  • Preparation for any type of major head or neck surgery in order to assist breathing during recovery.
  • Acute trauma to the head or neck causing obstruction to breathing
  • Other emergency situations when breathing is obstructed, and intubation had failed.

How it works?

A tracheostomy provides an air passage to help you breathe when the normal airway is partially or completely blocked.

Decanulation:

When a tracheostomy is no longer needed, the tube is replaced with a smaller size tube, and then gradually removed. The stoma is allowed to heal and close. For some people, a tracheostomy is permanent.

Complications of long term tracheostomy:

  • Obstruction of the tracheostomy tube
  • Dislocation of the tracheostomy tube from the trachea
  • Damage, scarring or narrowing of the trachea
  • Development of tracheoesophageal fistula (abnormal passage between trachea and esophagus), which can increase the risk of fluids or food entering the lungs
  • Any type of infection around the tracheostomy. Infection in the trachea and bronchial tubes (tracheobronchitis) and lungs (pneumonia) could also occur

If a patient needs to retain a tracheostomy after discharge from hospital, regular follow-up is needed for monitoring possible complications.

  • Bleeding from the trachea or at the tracheosotomy site
  • Difficulty breathing through the tube.
  • Pain or a change in comfort level
  • Redness or swelling around the tracheostomy
  • Dislocation of your tracheostomy tube

Care of tracheostomy tube

  • Keep the tube clean to prevent block and infection.
  • Suctioning to be done as required(visible secretions, noisy breathing) to keep the airway patent.
  • Change the catheter after every 8 hours and keep it clean and safe without contaminating.
  • Tracheostomy care is a clean procedure.
  • Whenever accessing the tracheostomy, wash hand thoroughly with soap and water.
  • Wear gloves and use hand rub.
  • Care of tracheostomy site

Change the dressing/Gauze piece kept around the tube daily and as and when it is dirty or wet. This will help in keeping the stoma clean, dry and healthy.

 Coping with dry air

As the air is not passing through normal airway, the air may be comparatively dry which can cause irritation, cough and excess mucus coming out of tracheostomy. Using a thermovent and regular nebulization may help.

Speaking

As the exhaled air bypasses the vocal cords, speaking is difficult with tracheostomy .But there are devices and techniques to produce voice. Skilled nurses and speech therapist will assist in learning to speak again.

Eating

Depending on the severity of illness, patient will be nourished on IV fluids, Tube feeding etc. Initally swallowing is difficult. As the wound heals and  patient is ready to eat again, a speech and swallow therapist or skilled nurse will assess the patient, help to regain muscle strength and coordination  for swallowing.

Signs and symptoms of blocked tracheostomy and immediate management

  • Breathing difficulty
  • Increased work of breathing
  • Oxygen saturation Less than 90%
  • Cyanosis( bluish discolouration of lips, nails)
  • Sweating,, cold and clammy skin

Immediate management

  • Thorough suction. If thick secretion of crust present, use diluted soda bicarb 2ml , instil directly inside the tube and do suction.
  • Deflate the cuff of the tube and then inflate.
  • Manually ventilate the patient using Bag Valve mask(AMBU). If resistance is felt while squeezing the AMBU, change the tracheostomy tube , by trained and experienced Therapist/Physician.

Why Suvitas is best for tracheostomy care.

  • In Suvitas, all patients are being managed with a personalized care plan by a multidisciplinary team.
  • In Suvitas, we have respiratory therapsit 24×7 for monitoring the tracheostomy patients and supporting the nurses.
  • Suvitas have skilled nurses, trained and experienced for expert management of tracheostomy cases .
  • Suvitas have 24×7 medical cover by a doctor.
  • Suvitas have single occupancy rooms which helps in preventing cross infection unlike hospital.
  • Suvitas adheres to infection prevention and control policies and standards.

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