Tracheostomy discharge information. Information for community nurses, patients and carers

Transcription

1 Tracheostomy discharge information Information for community nurses, patients and carers

2 What is a tracheostomy? A tracheostomy is a surgical incision (cut) through the neck tissues into the trachea leaving the whole voice box intact, and maintaining the connection of the lungs to the mouth and throat. What type of equipment will be required to care for a tracheostomy? Below is a list of the equipment you will need to care for a tracheostomy: Pen torch Soft tipped cleaning brushes Tracheostomy dressings Trachi-holder Cool boiled water Gauze Gloves Cuff manometer (if cuff present on tracheostomy tube) Make sure that you have a way of attracting attention at night if you need help. You may want to consider having an alarm or bell by your bedside or an emergency pendant. What type of tracheostomy tube will I have? Type of tube: page 2 of 8

3 How to care for your tracheostomy 1. Check that you / the patient can breathe freely and easily; use your hand to feel a good flow of air as you / the patient breathes out. 2. Hands should be washed and gloves worn for inner tube care. 3. Replace the tracheostomy ties / collars weekly or more frequently if they get dirty. This should always be a two person procedure. Changing the ties / collar may make you / the patient cough. Do not be alarmed. How do I care and clean for the inner tube of my tracheostomy? The inner tube should be removed a minimum of 4 hourly and checked to ensure the tube is open and there is no debris collecting that could cause crusting or blockage of the tube. The inner tube can be removed as often as necessary with the outer tube being left in place. The original inner tube should be removed and a temporary spare (red) clean inner tube inserted. Rinse and clean the inner tube in cooled boiled water to remove secretions; use a soft tipped brush if necessary. Remove the temporary (red) inner tube and re-insert the original clean inner tube. Clean the temporary (red) inner tube as described above, dry and store in a sealed container. Never leave the inner tube to soak because bacteria will grow in moisture and disinfectants. Always have a clean inner tube ready to put in when you are cleaning the dirty inner tube. page 3 of 8

4 How do I care for the tracheostomy site? The tracheostomy site should be checked daily. The site should be cleaned as necessary using cooled boiled water or normal saline. You can apply a tracheostomy dressing if necessary, under the tracheostomy tube. The tracheostomy dressing should not be of cotton wool or a dressing which sheds fibres as these types of dressings can remain in the stoma and cause inflammation around the tracheostomy site. Fenestrated and non-fenestrated tracheostomy tubes Fenestrated Non-fenestrated (solid inner) If you / the patient has a fenestrated inner tube in place, always change to a non-fenestrated (solid inner) tube at night. If you / the patient has a detachable speaking valve, this should also be removed before going to bed and kept in a dry place. page 4 of 8

5 Do I need to keep my airway warm and moist? In order to prevent your / the patient's airway from crusting and drying you / we will need to use either a filtration system or a heat and moisture exchange system suitable for a tracheostomy. Tracheostomy filters should be changed every 12 hours or more frequently if required. These will have been introduced to you / the patient before discharge from hospital. When will my tracheostomy tube be changed? The tracheostomy tube should be changed on a monthly basis by the team in charge of your / the patient's care. Will I need nebuliser therapy? It is important that a nebuliser is used on a regular basis to help loosen any secretions. This will enable the secretions to be coughed up easily out of the tracheostomy tube. We recommend that nebuliser therapy is used 4 times per day: morning, lunchtime, evening time and last thing at night. Nebuliser therapy can be used more often if necessary. Will I need suction? There will be occasions when you / the patient will be required to use a suction machine to help manage secretions. If this is necessary the equipment will be obtained and the necessary training will be provided to the patient and their families / carers. page 5 of 8

6 What should I do if the tracheostomy becomes blocked? 1. Remove the inner tube and replace with a clean one. 2. If you are still in difficulty, suction the tracheostomy tube Then either: a. If this relieves your symptoms, have a nebuliser immediately. You can contact the ENT outpatient department or the ENT ward for advice and arrange to come to hospital outpatients for a check-up. Or b. If you are still in difficulty, call 999 immediately. What should I do if the tracheostomy falls out? 1. Keep calm as you will still be able to breathe, but immediately: 2. Try to put the whole tube back into the hole. It goes in in the same direction as when you put the inner tube into the outer one. Use some water based gel e.g. Aquagel or KY jelly, to make this easier. 3. If this is difficult, try to put the next size down tube in the hole. 4. If you can t do this, call 999 and use the tracheal dilators to hold the hole open page 6 of 8

7 Useful contact numbers Ward I Ear Nose and Throat Outpatients Ear Nose and Throat Outpatients Appointments (Nurses' Station) Speech and Language Department Head and Neck Oncology Clinical Nurse Specialists page 7 of 8

8 Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2016 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD8939-PIL3807 v1 Issue Date: November Review Date: November 2018