A tracheostomy is an opening created, at the front of the neck so a special tube can be inserted into the windpipe (trachea) to help person to breathe. care of tracheostomy
A tracheotomy or a tracheostomy is an opening surgically created on the neck into the trachea or windpipe which allow direct access to the breathing tube.This procedure commonly done in an operation theatre under general anesthesia. A special tube is called tracheostomy tube, it usually placed through this opening to provide an airway and also remove secretions from the lungs.
How to Take Care of Tracheostomy
For care of tracheostomy…
- Give comfortable position the person lying supine with head elevated to not more that 30 degree.
- Ensure suction equipment is ready for use.
- Perform thorough hand-washing.
- Put on non-sterile gloves and remove dressing from tracheostomy site, ensuring that the tube is not displaced while doing so.
- Discard dirty dressing by holding it in one gloved hand and removing the glove over the dressing, the enclosed dressing may then be discarded.
- Wear Sterile Gloves.
- With sterile gauze and sterillium well squeezed till almost dry use aseptic technique to clean around the stoma and the flange of the tracheostomy tube.
- Use a sterile scissors to cut a key hole dressing in a sterile piece of gauze, apply dressing carefully between the tracheostomy and skin.
- Cut and remove ties and replace with clean ties.
- Ensure that the tube is tied firmly but should not be too tightly.
- Position the person comfortably.
- Take a sterile suction catheter.
- Wear sterile gloves.
- Portable suction machine to be checked whether it is working or not.
- Attached suction catheter to suction machine tube or central suction.
- Pinch the tube and insert in the trachea with aseptic technique
- Rotate the tube gently and then pull the catheter gradually after sucking out the secretion.
- Do not suck for more than 10 seconds, it damage the mucus membrane or person would be suffocated.
- If the secretions are thick, instill 2-3 ml of distilled water or normal saline solution and then do suction with using ambu bag
- If the secretions are thick instill 2-3 ml of sterile water or normal saline solution and then do suction or Tablet Kanthsudharak Vati (3 tablet four times a day) is started to that person,it helps to liquifies the secretion.
- Perform suction every half hourly and SOS or as and when required depending upon the amount of secretions.
Care of the Metal Tracheostomy Tube
- Remove the inner metal tube wearing plastic gloves and receive it in a clean tray.
- Wash the tube thoroughly well, using soap and water.
Note – If the secretions are thick – can soak it in soda bicarbonate solution for 15-20 minutes (Use brush to clear the inner wall of the tube).
- Autoclave the tube as required.
- If the person has only one tube, can boil it in the sterilizer for 15-20 mins.
- Then, place it in the tracheostomy opening after cooling it wearing sterile gloves.
- If the person has two sets of tracheostomy tubes then wrap it in the small tray and send it for autoclaving.
Note – The frequency of cleaning the inner tube will depend on the amount of secretions present.
- In case, if the outer tube needs to be changed, always ensure that the tracheal dilator / artery forceps is kept ready.
- Chest physiotherapy to be performed every 4 hourly.
- Provide nursing care related to back mouth, eyes, etc.
- Deflate the tube balloon for 5 minutes every 2 hourly.
- Do not deflate when the patient is on Ryles tube feeding (actually feeding).
- Always suction the person properly before you deflate the Ryle’s tube.