Tracheotomy Care at home 1

Management of tracheostomy care 1

Bismillahirahmanirahim , The term “tracheotomy” refers to the incision (otomy = opening) to provide an airway and allow for removal of secretions from lungs.  Breathing is accomplished through the tracheostomy rather than through the nose and mouth.  A tracheostomy can either be temporary or permanent.

What is Tracheostomy Facts ?

Tracheotomy is a surgical procedure that creates an opening in the cervical trachea (windpipe) allowing direct access to the breathing tube – rarely done as an emergency – secondary to oral or nasal intubation which is must faster and less complicated when managing respiratory arrest.

Why is a Tracheostomy performed?

• To bypass obstruction
• To maintain an open airway
• To remove secretions more easily
• To oxygenate and/or provide mechanical ventilation on a long-term basis

 Types of patients requiring tracheostomies?

• A comatose patient
• A patient with cancer of the larynx or neck
• Blockage of airway
• Inability to swallow or cough
• A burn patient with inhalation damage
• A COPD patient on mechanical ventilation
• A pediatric patient with a congenital airway obstruction
• ALS patients
• Plegic patients

Tracheostomy Anatomy

The tracheostomy can be performed in the OR or at bedside under moderate sedation.  The tracheostomy is usually formed between the second and third or third and fourth tracheal cartilages.

Percutaneous dilatational tracheostomy (PCT or PDT) is done at the patient’s bedside, usually in the ICU setting.  The procedure generally takes 15 minutes or less…bedside procedure (1/4 of patients) are contraindicated in a quarter of the patients – mostly due to anatomical irregularities or coagulation problems.

Landmark Of tracheostomy ?

Definition of Terms in Tracheostomy.

• Decannulation:  Removal of a tracheostomy tube
• HME:  Heat, moisture exchange (have pictorial)
• Humidification:  the mechanical process of increasing the water vapor content of an inspired gas
• Stoma:  a permanent opening between the surface of the body and an underlying organ (trachea and anterior surface of neck)
• Tracheal suctioning:  a means to clear the airway of secretions or mucus through the application of a negative pressure via a suction catheter

Temporary Tracheostomy versus Permanent Laryngectomy

Temporary:  THE UPPER AIRWAY WILL REMAIN PATENT IF THE TRACH TUBE WERE TO BE DISLODGED

Permanent:  THE LARYNX  IS REMOVED AND AN ARTIFICAL TRACHEOSTOMY IS CREATED – NO CONNECTION BETWEEN THE PATIENT’S UPPER AIRWAY AND THE TRACHEA ITSELF

Risks or complication of tracheostomy .

• Medication reaction
• Uncontrollable bleeding
• Respiratory problems
• Possibility of cardiac arrest
• Pneumothorax
• SC and/or mediastinal emphysema
• Tracheo-oesophageal fistula (development of a small connection between trachea and esophagus)
• Infection

Post procedural trach care:

The first days following tracheostomy are especially uncomfortable for the patient.  Namely – adjusting to the trauma of surgery, pain of a fresh incision, presence of a foreign object in the trachea, and the inability to communicate through speech. 

Patients commonly report choking sensations – generally takes one to three days to adapt to breathing through a trach tube

Potential Complications with Long-term Tracheostomy

• Thinning (erosion) of the trachea (trachemalacia)
• Development of granulation of tissue (bump formation in trachea
• Narrowing or collapse of the airway above the site of tracheostomy
• Once tracheostomy tube is removed, the opening may not close on its own
• Dysphagia; airway obstruction from secretions;
• Tracheal ischemia and necrosis

Higher risk for PCs exist for the following patient population:  children (newborns, infants); smokers; ETOH abusers; DM; immunocompromised patients; persons with chronic disease or respiratory infections; persons taking steroids or cortisone

Continued Assessment/SE after tracheostomy placement

• Subcutaneous emphysema (SCE) around stoma – air escapes into the tracheostomy incision creating SCE; generally of no clinical consequence – but can be palpated around the stoma site
• Excessive manipulation of the trach tube during coughing or suctioning can break improperly secured ties and dislodge the tube – (within the first 48 hours the freshly created stoma has a potential to close shut, constituting a medical emergency) – to minimize this risk, trach ties are not usually changed for 24 hours 
• First tube change is generally done by a physician after approximately one week (should have detailed Dr’s orders to always have a spare trach tube on hand – size should be indicated

Insha Allah  , in next blog entry i will continue another info regarding a tracheostomy  Care , its important for us to understand regarding a tracheostomy care for easy to manage and also give some info on that matters. wallahuaklam.