In tracheostomy nursing care, a tracheostomy is a procedure that involves creating an opening into the trachea via the neck just below the larynx. This incision is inserted into an indwelling tube, creating an artificial airway. Clients that need long-term airway assistance are the ones who utilize this device.
Tracheostomy tubes include a flange that rests against the neck and enables the tube to be fixed in place with tape or ties. The outer cannula of the tube is the part that is put into the trachea. Tracheostomy tubes also come equipped with an obturator, which is used to insert the outer cannula before it is subsequently withdrawn. If the tube gets dislodged and has to be reinserted, the obturator is kept by the side of the patient’s bed.
Nursing tracheostomy care Terms and Their Definitions
1. Decannulation
The procedure of removing a tracheostomy tube from a patient after determining that the patient no longer requires it.
2. Humidification
Adding a mechanical procedure raises the percentage of water vapour in a gas that has been inspired.
3. Stoma
An aperture in the body, either naturally occurring or produced by surgical intervention, through which a section of the body cavity may be connected to the outside world. This takes place between the trachea and the anterior surface of the neck.
4. Tracheostomy
A tracheotomy is a surgical technique that involves creating an opening in the trachea below the larynx by cutting through 2-3 (or 3–4) tracheal rings.
5. Suctioning of the Trachea
A technique involves applying negative pressure to the trachea and lower airway using a suction catheter to remove thick mucus and accumulated secretions.
6. Tracheostomy tube
A curved vacuous tube made out of plastic or plastic introduced into the tracheostomy stoma to help ease blockage, facilitate ventilators or remove tracheal secretions. Tracheostomy stomas are holes made in the neck and windpipe (Trachea).
Elements That Comprise a Tracheostomy Tube
· Inner tube
It slides in and out of the outer tube easily and is designed to be a tight fit.
· Flange
The patient has a flat plastic plate linked to the outer tube and lays flush against their neck. Fifteen millimetres around the outside: All ventilators and respiratory equipment may be used with it. The following features may all be skipped if desired.
· Cuff
An inflatable air reservoir with an enormous capacity but a low pressure holds the tracheostomy tube in place. It ensures maximal airway sealing with the least amount of local compression possible. To blow up, the air is pumped in via the.
· Air inlet valve
A one-way valve that stops the air that has been injected from escaping on its own.
· Air inlet line
The path that air takes from the air input valve to the cuff.
· Pilot cuff
It functions as a gauge to measure the volume of air contained within the cuff.
· Fenestration
A hole in the outer tube’s curvature improves airflow into and out of the trachea. Single or multiple fenestrations are offered.
· Tracheostomy button or cap, speaking valve
It is used to occlude the entrance of the tracheostomy tube during expiration to make it easier to speak and swallow and before decannulation during both inspiration and expiration to prevent air from escaping.
Providing Care for Patients with Tracheostomies
Purposes
- To clear mucus and hardened secretions to preserve the airways’ patency.
- To keep the tracheostomy site clean and to avoid getting an infection, there
- To hasten the healing process and protect the skin from becoming irritated around the tracheostomy incision
- To increase comfort
- To avoid displacement
- Assessment
- Condition of the patient’s lungs (ease of breathing, rate, rhythm, depth, lung sounds, and oxygen saturation level)
- Pulse rate
- Symptoms caused by secretions produced at the tracheostomy location (character and amount)
- Drainage present on the tracheostomy dressing or the ties
- Aesthetics of the incision (such as redness, swelling, purulent discharge, or odour)
Nursing interventions for tracheostomy care
The nursing interventions listed below are appropriate for a patient who has a tracheostomy.
- Provide the patient and any family members or caregivers with a thorough explanation of the process.
- You may want to think about using distraction tactics or getting medication before the procedure.
- If the patient is at an age where it is suitable, swaddle them by enveloping their arms in the sheet and keeping them contained in the sheet.
- Position the patient so that their neck is extended by placing the rolled towel beneath their shoulders (unless contraindicated). It’s possible that the more mature youngster may feel that sitting upright with their head leaned back is more comfortable.
- Place the youngster in a position that will provide you with adequate view and access to the stoma. If it’s required, stretch the neck even farther, and using your thumb and fingers, widen the opening where the stoma is located.
- Immediately before to removing the old tracheostomy tube and replacing it with the new one, it is necessary to suction the tube that is already in place.
Put trash in the appropriate container, take off your gloves, and practice hand hygiene.
Planning for the tracheostomy care nursing procedure
Because the care of nursing interventions for tracheostomy requires applying scientific knowledge, sterile technique, and the ability to solve problems, this kind of care can only be administered by a registered nurse or a respiratory therapist.
Equipment
- Kit or supplies for hygienic, disposable cleaning of a tracheostomy, including sterile containers,
- gauze squares, sterile applicators, sterile nylon brushes or pipe cleaners, and sterile applicators)
- Suction catheter kit that is sterile (suction catheter and sterile container for solution)
- Sterile normal saline (Check the organization’s protocol for the soaking solution.)
- Sterile gloves (2 pairs)
- Towel or drape to shield the bed linens from any damage
- A bag that can’t get wet
- Obtainable through commercial channels is tracheostomy dressing or sterile gauze measuring 4 inches by 4 inches
- Dressing
- Clean scissors
Nursing care plan for tracheostomy
This well-organized, fixed, step-by-step sequence of the whole nursing care plan for the tracheostomy procedure is drawn from Kozier & Erb’s Fundamentals of Nursing. The sequence can also be applied in pediatric tracheostomy nursing care
1. Make your introductions and verify the client’s identification following the procedure established by the agency
When working on a tracheostomy nursing care plan, clearly articulate to the customer everything that has to be done, why it is required, and how he may contribute to the solution. Blinking the eyes or lifting a finger may be used as a form of communication to signal that someone is in pain or discomfort.
2. Adhere to the correct tracheostomy care nursing steps infection control methods, such as practicing proper hand hygiene.
During tracheostomy care nursing procedure, all medical personnel have a duty to practice strict standards of infection control while caring for patients, and this is especially true when dealing with those who have had a tracheostomy and are receiving mechanical breathing. Infections may be microbial (gram-negative bacteria), viral (respiratory synctial virus, parainfluenza), or a combination of both (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococci, and b Haemolytic Streptococcus Group A).
Standard infection control practices (hand hygiene, PPE), decontamination of breathing equipment, lowering the risk of aspiration, lowering the amount of sedation required, better secretion control, and sufficient tracheostomy cleaning and care have all been linked to lower infection rates. The largest effect on decreasing infection risk will come through weaning and decannulation.
3. Ensure the client’s right to privacy
The protection of the patient’s privacy and the confidentiality of their medical information is an essential component of the healthcare system. It is an integral element of the role of medical professionals to maintain the confidentiality of the personal information that patients given to them.
Developing exhaustive rules and signing legally binding confidentiality agreements are two essential steps in the right direction when it comes to protecting the privacy of patients, along with ensuring that all information is housed on trustworthy systems.
- Get the customer and the necessary equipment ready
Assist the patient in assuming the semi-or Fowler Fowler’s posture to facilitate lung expansion.
Turn on the tracheostomy machine and have the sterile basins ready. The saturated solution and the sterile normal saline should each be placed in containers.
Create a sanitary working environment.
Prepare any additional sterile materials that may be required, such as sterile applicators, a suction kit, and a tracheostomy dressing.
5. If it is essential to suction the tracheostomy tube
Place a clean glove on the hand that is not your dominant one and a sterile glove on the hand that is your dominant one (or put on a pair of sterile gloves).
Remove any secretions from the tracheostomy tube by suctioning it throughout its length to maintain a clear airway.
After rinsing the suction catheter, wrap it around your hand, pull off the glove, so it flips inside out over the catheter, and secure it with medical tape.
Use the hand that is covered in the glove to unlock the inner cannula. To remove it, draw it toward you while carefully following the object’s natural curve. Please put it in the solution that’s meant for soaking. The rationale for this is that it lubricates and breaks up the secretions.
Take off the dirty dressing that was covering the tracheostomy. It would be best to start by placing the dirty dressing in your gloved hand, then peel off the glove so that it turns inside out over the dressing. Throw away the glove as an addition to the dressing.
Put on some sterile gloves. Maintain the cleanliness of your dominant hand throughout the treatment.
6. Clean the cannula’s inner chamber.
Take the inner cannula out of the fluid that it was soaking in.
You may use the brush or several pipe cleaners wet with sterile normal saline to thoroughly clean the lumen and inner cannula. The cannula should be held at eye level and inspected for cleanliness by peering through it into the light while it is being held.
Using the sterile normal saline, carefully yet wholly rinse the inner cannula.
After rinsing the cannula, please give it a few light taps against the inside rim of the sterile saline container. Only dry the inside of the cannula with a pipe cleaner that has been folded in half; do not dry the outside of the cannula. The reason for this is because by doing so, the surplus liquid is removed from the cannula, which eliminates the possibility of the patient aspirating it, and a film of moisture is left on the cannula’s outer surface, which lubricates it before it is reinserted.
7. Put the inner cannula back in place and ensure it’s secure.
To insert the inner cannula, grip the outer flange and insert the cannula along the direction of the flange curve.
Turning the lock (if one is provided) into position will allow you to fasten the inner cannula’s flange to the outer cannula and lock the cannula in place.
8. Clean the area where the incision was made and the tube flange.
The incision site should be cleaned with sterile applicators or gauze dressings that have been soaked with normal saline. Use the hand you usually work with to handle the sterile items. Before throwing it away, you should only use each applicator or gauze dressing once. The logic is to prevent a contaminated gauze bandage or applicator from infecting an otherwise clean region.
To get rid of crusty secretions, hydrogen peroxide may be used (often in a half-strength solution mixed with sterile normal saline; use a separate sterile container if required). Check agency policy. The area that has been cleansed should be thoroughly rinsed using gauze squares soaked with sterile normal saline. This is because hydrogen peroxide may irritate the skin and can slow the healing process if it is not eliminated.
In the same way, clean the flange on the tube.
Gauze squares should thoroughly dry the client’s skin and the tube flanges.
- Cover the wound with a sterile dressing.
Use a tracheostomy dressing professionally prepared with a material that does not ravel, or open and refold a gauze dressing 4 inches by 4 inches into a V shape. Avoid using cotton-filled gauze squares and cutting the gauze 4 inches by 4 inches. The patient can breathe in cotton lint or gauze fibres, which might result in an infection of the tracheal cavity.
The dressing should be positioned to fit beneath the tracheostomy tube’s flange.
While applying the dressing, ensure that the tracheostomy tube is maintained safely and stably. The trachea becomes irritated when there is an excessive movement with the tracheostomy tube.
10. Adjust the ties that hold the tracheostomy in place.
Alter as necessary to maintain a clean and dry surface on the skin.
Available options include twill tape as well as specifically produced Velcro ties. However, it is easily dirty and may trap moisture, which can lead to irritation of the skin around the neck. Although affordable and frequently accessible, twill tape has several drawbacks. The usage of Velcro as a fastening method is gaining popularity. They are far broader, more comfortable, and cause significantly less abrasion to the skin.
11. The Method of Two Strips (Twill Tape)
To create two uneven strips of twill tape, cut one to a length of around 25 centimetres (10 inches) and the other to approximately 50 centimetres (20 inches). Reasoning: By making one of the tapes longer than the other, it will be possible to secure them at the side of the neck, which will make them easier to reach and will prevent the pressure that would be exerted by a knot on the skin at the back of the neck.
Approximately 2.5 centimetres (1 inch) from one end of each strip, cut a longitudinal incision measuring 0.5 inches (lcm). To do this, first, fold the end of the tape over approximately 1 inch (2.5 centimetres), then cut a slit in the centre of the tape from the edge where it has been folded.
After the previous ties have been left in place, thread the slit end of one clean tape through the eye of the tracheostomy flange from the bottom side. Next, thread the long length of the tape through the slit, and pull it tight until it is firmly tied to the flange. The tracheostomy tube is less likely to get accidentally dislodged if the old ties are allowed to remain in place while the new, clean ties are secured. By securing the tapes this way, knots, which may become undone or create pressure and discomfort if they are already present, are avoided.
If the old ties are dirty or it is difficult to thread new ties onto the tracheostomy flange with the old ties still in place, have an assistant put on a sterile glove and hold the tracheostomy in place while you replace the ties. This is necessary if the old ties are difficult to thread new ties onto the flange with the old ties in place. This is highly significant since any tube movement during this treatment might potentially irritate the patient’s throat and cause them to cough. If the ties are not securely fastened, coughing may cause the tube to dislodge.
Proceed in the same manner as before with the second tie.
Request that the patient stretch their neck. After sliding the longer tape under the client’s neck, slip a finger in the space between the tape and the client’s neck, and then knot the two tapes together on the client’s side of the neck. The rationale behind this is that flexing the neck expands the diameter of the neck in the same manner as coughing does. By inserting a finger beneath the tie, one may prevent the tie from becoming too tight, which might impede one’s ability to cough or apply pressure on the jugular veins.
Square knots should be used to secure the ends of the tapes. This is an essential component in nursing skill tracheostomy care. Remove any excess length, leaving a margin of around 1 to 2 centimetres (0.5 in.). The rationale is that square knots prevent the rope from slipping and loosening. The presence of enough ends beyond the knot helps to prevent the knot from coming undone by accident.
As soon as the clean ties have been fastened, remove the dirty ties and throw them away.
The Method of One Strip (Twill Tape)
Cut a piece of twill tape two and a half times longer than the required length to wrap around the customer’s neck from one tube flange to the other.
- The first step is to insert one end of the tape into the slot on one of the flange’s sides.
- Bring together the two opposite ends of the tape. When doing so, place them around the customer’s neck straight and untwisted.
- Put the end of the tape adjacent to the customer’s neck into the slot running from the rear to the front of the device.
- Request from the client that they stretch their neck. As with the two-strip approach, secure the loose ends with a square knot at the client’s side of the neck. To allow for slack, use two fingers underneath the ties. Remove excess length by cutting.
11. Cover the tying knot with tape and padding.
After placing a gauze square that is 4 inches by 4 inches and has been folded over, place tape over the knot in the tie, the rationale behind this is that this will lessen skin discomfort caused by the knot and will prevent the knot from being confused with the client’s gown ties.
12. Ensure that the knots are pulled as tightly as possible.
Check the location of the tracheostomy tube and the tightness of the ties that hold the tracheostomy in place regularly. The swelling of the neck may cause the ties to become overly tight, which may interfere with the patient’s ability to cough and slow down circulation. When a patient is agitated, the ties may become loose, which makes it possible for the tracheostomy tube to protrude from the stoma.
13. Make sure to document any pertinent information.
Document the suctioning, care for the tracheostomy and change the dressing, and note your evaluations.
Conclusion
It is recommended that a multidisciplinary team approach be used while providing care for a patient who has a tracheostomy. Changing the dressing at the site regularly and performing suctioning as needed should be part of everyone’s effort to keep the wound clean and dry. Delivering the highest possible care to your patients will be much easier if you always have the appropriate emergency supplies readily accessible. Suppose you need any help with your tracheostomy writing, feel free to reach out at nursingpapers.com. Our experts are keen on instruction using the suitable tracheostomy care nursing skill template. They can also help on various projects such as tracheostomy nursing care PowerPoint.
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