The essential principles of tracheostomy care
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1 The essential principles of tracheostomy care Deborah Dawson Consultant Nurse Critical Care Excellence in specialist and community healthcare
2 Key publications
3
4 Aims Stoma Care Inner cannula management Infection Control Secretion Management Humidification Communication & Swallowing Emergency Situations Essential Principles of Tracheostomy Management / St George s University Hospitals NHS Foundation Trust
5 Dressings Hyperoxygenate and suction prior to procedure if required Neck slightly extended, then flex to fasten holder Daily inspection of stoma, swab if looks infected Clean with normal saline Apply thin, pre-cut keyhole dressing and holder If excoriated film forming acrylate barrier Document Essential Principles of Tracheostomy Management / St George s University Hospitals NHS Foundation Trust
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7 Inner cannula care Should be used routinely What about patients on Mechanical Ventilation? Inspected four hourly Cleaned with sterile water or saline Dispose of cleaning fluids in a sluice Kept in a dry sealed box Documentation Essential Principles of Tracheostomy Management / St George s University Hospitals NHS Foundation Trust
8 Cuff management Check once a shift or if tube or patient moved Methods: Cuff manometer (20-25cmH2O) Minimal occlusion volume Continuous measurement High pressure potential causes Too small tube Poor tube positioning Over-inflated cuff Reduced lung compliance Essential Principles of Tracheostomy Management / St George s University Hospitals NHS Foundation Trust
9 Impaired humidification Increased viscosity of mucus Depressed ciliary function Increased risk of infection Micro-atelectasis Impaired secretion removal Obstruction of major airways Tube blockage Decreased cough Infection Essential Principles of Tracheostomy Management / St George s University Hospitals NHS Foundation Trust
10 Humidification Systemic hydration Heat-moisture exchanger (HME) Heated water humidifiers Venturi humidifiers (cold water) Nebulisation Mucolytic agents Buchanon Protector Essential Principles of Tracheostomy Management / St George s University Hospitals NHS Foundation Trust
11 Secretions/Suctioning Assess need Respiratory vs. oral Cough vs.yankauer Invasive reserved for patients unable to clear own secretions Pre-oxygenate kPa vacuum ID mm -2x2 (cuffed tubes) Non-fenestrated inner cannula Insert 10-15cm, stop if resistance felt and withdraw 2cm Essential Principles of Tracheostomy Management / St George s University Hospitals NHS Foundation Trust
12 Oral hygiene Daily assessment of mouth Twice daily oral care Toothbrushing 2% Chlorhexidine gel QDS Cleaning dentures Lip salve Oral fluids where possible to maintain saliva production (Cuff up or down?) Essential Principles of Tracheostomy Management / St George s University Hospitals NHS Foundation Trust
13 Swallow Cuff will interfere with swallowing mechanics of larynx The muscles can waste if not used Predictors of swallowing difficulty: Head and neck surgery Lower cranial nerve palsy Clinical signs of aspiration Weak wet or gurgly cough during trials of cuff deflation The essential principles of tracheostomy care / St George s University Hospitals NHS Foundation Trust
14 Speaking valve The essential principles of tracheostomy care / St George s University Hospitals NHS Foundation Trust
15 Emergency Scenarios Functioning suction facilities Appropriate sized suction catheters Yankauer sucker Adult bag-valve-mask with reservoir with tubing Oxygen Spare tracheostomy tubes (one of the same size and one a size smaller) usually the same type but must be a type that can easily be inserted in an emergency situation Tracheal dilators Tracheostomy disconnection wedge Water soluble gel Essential principles of tracheostomy care/ St George s University Hospitals NHS Foundation Trust
16 Presentation title / St George s University Hospitals NHS Foundation Trust
17 Video e=youtu.be Essential principles of tracheostomy care/ St George s University Hospitals NHS Foundation Trust
18 Thank you, any questions? Essential principles of tracheostomy care/ St George s University Hospitals NHS Foundation Trust
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