Tracheostomy Care Lindsay Gambit, Sara Lum, & Brian Palmer Nevada State College School of Nursing 2010 What is a tracheostomy? Surgical incision in the trachea Tracheostomy tube acts as Opening is called airway a stoma Tracheostomy tube must be Tube is inserted clear of secretions to allow air toflow in and out Tracheostomy tube isof lungs approximately size of individual’s little finger Reasons for Tracheostomy Structural/muscular abnormalities in airway Apnea (no breathing) or pauses in breathing Abnormal growth in airway that interferes with breathing Injury or burn to the head/neck that cause airway to swell Types of Tracheostomy Tubes Uncuffed, single cannula Uncuffed, double cannula(most common) Cuffed, double cannula Cuffed, single cannula Additional Pieces to Trach An “artificial nose” helps: OBTURATOR:A guide placed inside the tube when• Hold your child’s own warmth and the tube is being inserted. moisture in the airway. The obturator is removed immediately after the tube• Filter small objects from the is placed. airway.Passy-Muir Valve (PMV):increases speech production & improves swallowing Safety MeasuresTracheostomies bypass the body’s normal filtering process: Do not use powders or aerosols around child Keep small particles such as sand, glitter, lint, chalk away from student’s tracheostomy Keep small pieces of food or water away from tracheostomy Keep glue or chemicals with strong fumes away from child Responsibilities of UnlicensedPersonnel1. Suctioning2. Removal and insertion of tracheostomy tubeOnly in cases of emergency -signs of respiratory distress (see next slide) SuctioningPurpose Signs & symptoms of respiratory distress Students with tracheostomies are often unable to cough in Grunting, noisy breathing order to clear mucous Difficulty breathing Increased rate of breathing – If tracheostomy is plugged, student cannot properly very fast or very slow breathe Pale, blue color around the lips, A plugged tracheostomy tube nails, & eyes can be life-threatening Flaring nostrils (move in and Suctioning almost always clears out when breathing) tracheostomy tube of Restlessness secretions Sweating or “clammy” skin Anxious, frightened look A catheter that fits into the Production of large amounts of tracheostomy tube is attached to suction machine to perform secretions that are not suctioning removed from the trachea by coughing Suctioning Equipment Portable Suction machine Suction connection tubing Sterile suction catheter Gloves Water/Saline BVM (resuscitation bag) Position for suctioning, tuberemoval, & insertion Steps for suctioning Wash hands Put on gloves Use one gloved hand to hold suction end of catheter & protect catheter from touching anything Attach catheter to suction machine If child has artificial nose or Passy Muir, hold outer cannula and remove artificial nose/Passy Muir Gently insert catheter into tracheostomy to specified depth indicated Cover thumbhole on catheter to apply suction Gently twist the catheter as it is being removed Remember child is not getting oxygen during suctioning. Complete procedure should be < 5 seconds! Discard suction catheter & gloves Wash hands Suctioning Suction depth Pre-measured technique for routine suctioning based on school nurse assessment Pre-marked catheters Deep technique increases risk of epithelial damage Only twist catheter during removal. Never twist catheter during insertion. Do not insert suction catheter beyond the tip of the tracheostomy tube. Emergency Trach Tube Removal If suctioning fails to remove “plug” in tube call 911 Roll a towel or blanket under child’s shoulders so head is tilted slightly back or position per careplan Put on gloves Open new tube & insert obturator into new tube Lubricate the end of the new tube with water-soluble lubricant/sterile water if provided A partner may have to restrain child’s arms while tube is removed Gently remove old tube (deflate cuff if applicable) Emergency Trach Tube Insertion Gently insert new tracheostomy tube Quickly remove obturator, while holding outer edges of tube wings to prevent decannulation (inflate cuff if applicable) Suction if indicated Continue to monitor child’s breathing Secure tracheostomy tube with tracheostomy ties or hold tube in place until 911 arrives Remove gloves CPR with Tracheostomy:Unconscious Student Call 911 Put on gloves Begin with Chest Compressions (30:2) Remove tracheostomy tube Pulmonary resuscitation with mouth to mouth Pinch nose, cover stoma with gloved finger and proceed to ventilate using a barrier device Pulmonary resuscitation with mouth to stoma Close mouth, pinch nose, and then proceed to ventilate using a barrier device BVM (licensed nurse only); if unable to ventilate follow above protocol ReferencesBerman, A., Snyder, S., Kozier, B. & Erb., G. (2008) Fundamentals of nursing: Concepts, process, and practice, 8th Edition. Upper Saddle River, NJ: Pearson Education Inc.Components of tracheostomy care. Retrieved September 8, 2009 from http://www.thoracic.org/sctions/education/care-of-the-child-with-a- chronic-trahceostomy/components-of-tracheostomy-care/index.htmlGodson, R. (2009). Our children deserve a better deal on school nurses. Nursing Times.Higgins, D. (2009). Basic nursing principles of caring for patients with tracheostomy: The basic principles of nursing care and monitoring for patients with tracheostomies. Nursing Times, 105(3), 14-15Individuals with disabilities education act (IDEA): Management of children in least restrictive environment. (2008). Retrieved on September 22, 2009 from http://www.nasn.org/Default.aspx?tabid=149Koziol, Cindy. Personal interview on September 21, 2009Lipe, S. & Beasley, S. (2004). Critical thinking in nursing: A cognitive skills workbook. Philadelphia: Lippincott Williams & Wilkins ReferencesMyers, S. & Sharp, D. (2005). Emergency ventilation of the tracheostomy patient, part I: A story of tracheostomy history and patient management: Advocating education for emergency resuscitation. Otorhinolaryngology Journal, 23(1)Smith, J., Williams, J., & Gibbin, K. (2003). Children with tracheostomy: Experience of their carers in school. Child: Care, Health, & Development, 29(4), 291-296Tracheostomy, Retrieved September 12, 2009 from http://www.nlm.nih.gov/medlineplus/ency/article/002955.htmlTracheostomy Care, Retrieved September 8, 2009 from http://my.clevelandclinic.org/head_neck/patients/head_neck_cancer/tr acheostomy_care.aspxTracheostomy care handbook: A guide for the health care provider. Retrieved on September 12, 2009 from http://www.nbngroup.com/manuals/machine/tracheostomy-care- handbook.pdf
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Description: Tracheostomy Care Lindsay Gambit, Sara Lum, & Brian Palmer l l Ct t Nd SN evada State College School of Nursing 2010
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