Tracheostomy : Tracheostomy Conducted by: SACHINWADHWA ADESH COLLEGE OF NURSING MUKTSAR introduction: introduction A surgical procedure in which an incision is made into the trachea, through the neck, and a tube inserted so as to make an artificial opening in order to assist breathing. Or A tracheostomy is the surgical creation of a stoma or opening into the trachea through the overlying skin The indwelling tube inserted into the trachea is called tracheostomy tube A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. Cont……………………d: Cont……………………d It can be performed as an emergency procedure or an elective procedure. A traheostomy provides the best route for long term airway maintenance. General anesthesia is used. The neck is cleaned and draped. Surgical cuts are made to expose the tough cartilage rings that make up the outer wall of the trachea. The surgeon then creates an opening into the trachea and inserts a tracheostomy tube. Indication of procedure: Indication of procedure Relief of acute or chronic upper airway obstruction. access for continuous mechanical ventilation. Prevention of aspiration pneumonia A large object blocking the airway An inherited abnormality of the larynx or trachea Cont……….d: Cont……….d Breathed in harmful material such as smoke, steam, or other toxic gases Cancer of the neck, which can affect breathing Breathed in harmful material such as smoke or steam Paralysis of the muscles that affect swallowing Severe neck or mouth injuries When client can't breathe on his own Tracheostomy tubes: Tracheostomy tubes A tracheostomy (trach) tube is a curved tube that is inserted into a tracheostomy stoma (the hole made in the neck and windpipe). Tracheostomy tubes vary in composition ,shape ,& size. Incorrectly fitted tubes can precipitate permanent or life threatening damage. The diameter of a tracheostomy tube should be smaller than the trachea . Cont………………………d: Cont………………………d The tracheostomy tube may be long and angles with the ranging from 50 to 90 degree. Tracheostomy tubes are made of various substances: Nonreactive plastic ,stainless steel ,sterling silver or silicon. Plastic tubes are disposable and used for only one person. Metal tubes may be reused after being sterilized. Risks : Risks The risks for any anesthesia are : Problems breathing Reactions to medications The risks for any surgery are : Bleeding Infection Additional risks include : Nerve damage Scar tissue in the trachea Potential problems associated: Potential problems associated Tracheal wall necrosis Tracheal dilation Tracheal stenosis Tracheomalacia Airway obstruction Infections Accidental decannulation Subcutaneous emphysema tracheostomy advantages: tracheostomy advantages Less irritation of nose, mouth and throat mucous membranes A nasal tube carries a higher risk of incurring sinusitis Cleansing the mouth is much easier to perform thus preventing oral cavity infections The patient is more able to cough up mucus . Ability to speak When awake and if the patient can swallow and his condition allows it, he may eat and drink Pre-procedure care: Pre-procedure care For client who are to undergoing elective tracheostomy ,reinforce education provided by the physician. The client’s understanding of the tracheostomy tube may be enhanced by looking at anatomic diagrams & by handling a tracheostomy tubes. If the tracheostomy is expected to be permanent ,information about living a productive life with modification. procedure: procedure The surgical procedure is usually performed in the operating room or in an intensive care unit ,where the pt’s ventilation can be well controlled and aseptic technique can be maintained. The patient is made to lie down on their back with the neck & head extended by keeping a pillow under the shoulder and neck. Local anaesthesia or general anaesthesia is used for the procedure A surgical opening is made in the second & third tracheal ring. Surgical techniques (Open procedure): Surgical techniques ( Open procedure) Cont…………..d: Cont…………..d Cont….d: Cont….d The skin is separated and surrounding tissues are dissected to expose the trachea. A suitable size tracheostomy tube is then introduced inside. While choosing the tube, the smallest feasible tube should be used. A general rule is that the tube should be three fourths of the diameter of the trachea. The incision is closed using skin sutures by the side of the tracheostomy tube Dressing is applied for the wound to heal Percutaneous tracheostomy : Percutaneous tracheostomy Post procedure: Post procedure If the tracheostomy is temporary, the tube will eventually be removed. Healing will occur quickly, leaving a minimal scar. If the tracheostomy tube is permanent, the hole remains open and may require surgical closure when no longer needed. Normal lifestyles are encouraged and most activities can be resumed. Patients must adhere to other safety precautions regarding exposure to water, aerosols, powder, or food particles as well. Post procedure care: Post procedure care Many of the patients need 1 to 3 days time to adapt themselves to breath through the tracheostomy tube. Painkillers and antibiotics are given as per the patients need. The patient will have to try and make adjustments to communicate. It would be very difficult for the patient to initially make any noise or sounds let alone trying to speak. tracheostomy care: tracheostomy care Suctioning Skin care Inner tube care Not aggressive and not too much deep To prevent irritation and secondary inflammation due to discharge Once or more daily remove and clean. Attention on crusts Cont…………………..d: Cont…………………..d Humidification Tube position Tube position Artificial nose ” To prevent decubitus of trachea Not to cover with blanket! Pay attention on patient’s beard and chin position! PowerPoint Presentation: TYPES OF TRACHEOSTOMY TUBES CUFLESS TUBES CUFFED TUBES Suctioning the tracheal tube: Suctioning the tracheal tube When tracheostomy is in place ,it is necessary to suction the pt’s secretions. Tracheal suctioning is performed when adventitious breathe sounds are detected. Unnecessary suctioning can initiate bronchospasm & cause mechanical trauma to the tracheal mucosa. All equipments that comes into direct contact with the pt’s lower airway must be sterile to prevent pulmonary & systemic infections. Nursing care of the pt with a tracheostomy tube: Nursing care of the pt with a tracheostomy tube NSG INTERVENTION Gather the needed equipments ,including sterile gloves ,hydrogen peroxide ,normal saline solution or sterile water ,cotton tipped applicators ,dressing Provide pt & family instructions on the tracheostomy care RATIONALE Everything needed to care for a tracheostomy should be readily. The tracheostomy dressing is changed as needed to keep the skin clean & dry. Cont……d: Cont……d Perform hand hygiene Explain procedure to pt & family as appropriate Put on clean gloves ,remove & discard the soiled dressing in a biohazard container Prepare sterile supplies, including hydrogen peroxide ,normal saline or sterile solution ,cotton tipped applicator ,dressing & tape. Hand hygiene reduces bacteria on hands. For support & knowledge To reduce cross contamination Having necessary supplies & equipments readily available allows the procedure to be completed efficiently . Cont…………….d: Cont…………….d Put on sterile gloves Clean the wound and plate of the tracheostomy tube with sterile cotton tipped applicator moistened with hydrogen peroxide . Rinse the inner cannula in peroxide & then with saline solution or replace with a new disposable inner cannula. Sterile equipments minimizes transmission of infection Hydrogen peroxide is effective in loosening crusted secretions. Soaking loosens & removing secretions from the inner lumen of tracheostomy tube. Cont………………..d: Cont………………..d Place clean tape in position to secure the tracheostomy tube. To secure tracheostomy tube.