Tracheostomy Management

What Is a Tracheostomy?

A tracheostomy is a medical procedure, either temporary or permanent, that involves creating an opening in the neck in order to place a tube into a person’s windpipe.

  1. Tracheostomies are performed for many reasons related to a blocked airway or a need for prolonged respiratory or ventilator support.
  2. During a tracheostomy, a tube is inserted into your windpipe to open the restricted airway and enable breathing.
  3. Tracheostomies are also known as stomas. This term refers to the hole in the neck that the tube is inserted through.

Reasons for a Tracheostomy Procedure:

  • To bypass an obstructed upper airway e.g. an object obstructing the upper airway will prevent oxygen to reach the lungs
  • To clean and remove secretions
  • Could be used when a disease or other problem makes normal breathing impossible.

 

Conditions that may require a tracheostomy tube:

  • People with severe allergies
  • Birth defects of the airway
  • Cancer in the neck
  • Chronic lung disease
  • Coma
  • Injury to the chest wall, or injury to the larynx
  • Obstruction of the airways by a foreign body
  • Tumors

Risks specific to a tracheostomy:

  • Damage to the thyroid gland in the neck
  • Erosion of the trachea, which is rare
  • Lung puncture and lung collapse
  • Scar tissue in the trachea.

Tracheostomies are becoming commonplace within the acute hospital settings, in the community as well as specialised nursing homes

Tips for taking care of a tracheostomy at home:

Homecare of the tracheostomy is very important therefore:

  • Always wash your hands with soap and water and wear gloves before dealing with the tracheostomy tube and stoma
  • Stoma should be cleaned every day or when required, if soiled, with sterile water and gauze to prevent infection
  • The dressing and the straps should be also changed on the daily basis or more often if required
  • Inner canula should be changed and cleaned every 2 to 4 hours or when required
  • Make sure airways are moist, so the humidification device is always in situ, otherwise the secretions might get dry and the tube would be at risk of getting blocked
  • If there are secretions underlying and unable to cough, make sure deep suctioning is performed so the secretions are removed.
  • Make sure an appointment is set up every month (28 days) to change the entire tracheostomy tube, to reduce chances of infections.

Recognising Warning Signs:

You should contact your doctor if any of this happening:

  • Smelly secretions coming from the tracheostomy tube
  • Bright red blood
  • A significant increase in the amount of secretions
  • Irregular heart rate and difficulties in breathing and is not relieved by the usual method of clearing secretions
  • If secretions become thick or secretions plug are present, so your doctor could recommend increasing fluids or prescribe nebulisers.

Emergency situations:

  • If you have issues breathing, remove the inner cannula straight away and replace it with a clean one. If your breathing improves, the inner cannula was most likely clogged.
  • If your breathing does not get better, deflate the cuff with the syringe for air to pass through your mouth and nose and call 911 or go to the nearest emergency room immediately.
  • If the entire tracheostomy tube is removed by accident, do not panic. The tract will stay open for hours to days. Call 911 or go to the nearest emergency room immediately to have it put back in.
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