Indications and Trach care goals
- relief of acute or chronic upper airway obstruction (trauma, surgery, edema, tumor)
- Facilitates removal of secretions
- promotion of pulmonary hygiene
- access for long-term mechanical ventilation
- Permits oral intake and speech in long term ventilated patient.
TRACHEOSTOMY CARE GOALS
- To ensure airway patency
- To maintain mucous membrane and skin integrity
- To prevent infection
Advantages of a Tracheostomy
- Less risk of long term airway damage
- Patient comfort (no tube in mouth)
- The patient can eat (not all patients)
- Allows for more mobility (trach tube more secure)
Factors that influence tracheostomy airway functioning
- hydration: dehydration = thick mucus
- humidity: dry air = crusting of mucus
- infection: thick secretion, makes lungs have more secretions
- nutrition: better nutrition = better healing
- ability to cough: unable to cough = no protective mechanism
**H H I N A **
Why is first tube not changed by MD no sooner than 7 days why?
there could be some fresh inflammation therefore need to wait for inflammation to decrease, needs healing tissue and to allow stoma to form membrane around trach
Suctioning principles
Goal is to maintain a patent airway and oxygenation
- Non invasive before suctioning: d b and c, inceptive spirometer, positioning, ambulation
- If secretions can be effectively coughed and expelled, there is no need to suction.
- Need to use aseptic technique as lower airway is considered sterile.
- *Assess: before, during, after
Expect increased need for suctioning:
- fresh trach
- impaired cough reflex
- sedation, decreased LOC
- neuromuscular disease affecting chest or abdominal muscles
- pulmonary infection
Potential signs of Lower Airway Obstruction (need to suction)
- secretions in trachea
- ineffective cough
- wheezes, crackles, gurgles, decreased breath sounds on auscultation
- tachypnea, tachycardia, elevated BP
- dyspnea, SOB
- shallow respirations
- chest asymmetry
- cyanosis
- decreased oxygen saturation
- decreased LOC
agitation, confusion
Problems
Early
- Hemorrhage
- Pneumothorax
Later
- Infection pneumonia
- Obstruction
- Decnannuation
- Tracheal fistula
Even later
- Tracheal stenosis
SECONDARY TO CUFFS
OTHER:
- airway obstruction
- infection
- risk of aspiration
- impaired verbal communication
- anxiety and fear
- potential constipation
CUFF RELATED PROBLEMS
- Tracheal Dilation
- Tracheal Stenosis
- Tracheal Wall Necrosis
Complicatins: Blocked Trach
_Blocked Trach: _
- Cuff deflated but patient cant breathe around the trach – cardiac arrest
- Cuff deflated and patient breathe around trache
Help
Obstructed tube
- Assess patency
- Remove inner cannula
- Pass suction cathether
Weaning and Dysphagia (why is patient at Risk?)
Weaning
- change to a cuffless tube
- may decrease size of tube
- plug for intervals
- readiness for removal
Dysphagia
- coughing
- wet, hoarse voice
- throat clearing
- increased coughing
- pocketing of food, drooling
- no swallow, multiple swallows, delayed swallow
- pt states “food stuck” in throat
Why is pt at risk?
- reduced sensation
- decreased coordination
- reduced protective mechanism i.e. cough
- reduced motion of swallowing mechanism
- air pressure changes
Documentation
- date and time
- all procedures performed (i.e. drsg change, cleaning of inner cannula, suctioning, etc.)
- amount, color, consistency and any odor of the secretions
- appearance of the stoma and condition of the skin
- record any changes made of the trach tube, inner cannula, or trach ties
- record the duration of any cuff deflation (as per hospital policy)
- record the amount of cuff inflation (as per hospital policy)
- note any ability of the patient to speak
- record respiratory status and breath sounds
- document any patient teaching that you did
