Tracheostomy Care Service

Why would a tracheostomy be performed?

There are a number of different reasons a tracheostomy might be considered, these include:

• Long-term need for a ventilator
• Airway protection following surgery
• Airway reconstruction following surgery to the trachea or larynx
• Breathing difficulty caused by swelling, infection or lung conditions
• Obstruction to the throat through the mouth

What is tracheostomy patient care?

A tracheostomy works by inserting a small tube to the neck to keep the opening (also known as the stoma) clear. Tracheostomy tubes are available in a multitude of sizes and materials depending on their usage, how often they will be used and who is using them. They can either be disposable or reusable and range from rigid or semi-flexible plastic to metal. The tubes can also be cuffed or not cuffed. A cuff is a small balloon at the end of the tube which can help to seal off the airway and protect against any material being inhaled into the lungs. Those which are cuffed are normally used for patients receiving medical ventilation or who have difficulty swallowing, whereas non-cuffed tubes are usually used to maintain an airway when a ventilator is not needed.

Who can provide the best tracheostomy care service?

Once you have got a tracheostomy fitted it’s important to treat it with proper care. If this doesn’t happen it could lead to infections and complications such as difficulty swallowing or breathing. Care of the tracheostomy could involve suctioning to prevent any obstructions, removing secretions and replacing any necessary supplies.

Our at home tracheostomy care team can help with this, negating the need to travel to a clinic. We will create a dedicated care plan that will be reviewed daily and updated if there are any changes required. All our staff members are trained to recognize and deal with any complications that may arise from a tracheostomy such as infection or respiratory distress and will be on hand whenever you need.

We will care for your medical needs with your tracheostomy such as:

• Trachea and cuff changes
• Inner and outer tube changes
• Airway management
• Assistance with any medication you might need
• Providing expert advice on your trachea to you and your loved ones

We will also help with the more practical elements of living with a tracheostomy. These are more likely to be needed when you first come home from hospital, but we have a range of both long- and short-term options to suit you.

• Assistance with shopping and meal preparation
• Help around the house
• Assistance getting around your home
• Picking up prescriptions

At Patient Attendant Service our tracheostomy care team are on hand to help with all aspects of your care and we will always put your needs first.

If you are looking for tracheostomy care in Delhi, Noida , Gurgaon , Faridabad, be sure to get in touch with us today.

Planning For Tracheostomy Price

Suctioning a tracheostomy or endotracheal tube is a sterile, invasive technique requiring application of scientific knowledge and problem solving. This skill is performed by a nurse or respiratory therapist and is not delegated to UAP.

• Equipment
• Resuscitation bag (Ambu bag) connected to 100% oxygen
• Sterile towel (optional)
• Equipment for suctioning
• Goggles and mask if necessary
• Gown (if necessary) as Sterile gloves
• Moisture-resistant bag

Dealing with Emergencies

• If the tracheostomy tube falls out DON’T PANIC!
• Once the tracheostomy tube has been in place for about 5 days the tract is well formed and will not suddenly close.
• Reassure the patient Call for medical help.
• Ask the patient to breathe normally via their stoma while waiting for the doctor.
• The stay suture (if present) or tracheal dilator may be used to help keep the stoma open if necessary.
• Stay with patient.
• Prepare for insertion of the new tracheostomy tube, Once replaced, tie the tube securely, leaving one finger-space between ties and the patient’s neck.

Check tube position by

(a) asking the patient to inhale deeply – they should be able to do so easily and comfortably, and

(b) hold a piece of tissue in front of the opening – it should be “blown” during patient’s exhalation.

Tracheostomy-Nursing-Care-Management

A tracheostomy is an opening into the trachea through the neck just below the larynx through which an indwelling tube is placed and thus an artificial airway is created. It is used for clients needing long-term airway support.

Tracheostomy tubes have an outer cannula that is inserted into the trachea and a flange that rests against the neck and allows the tube to be secured in place with tape or ties. Tracheostomy tubes also have an obturator which is used to insert the outer cannula which is then removed afterwards. The obturator is kept at the client’s bedside in case the tube becomes dislodged and needs to be reinserted.

Nurses provide tracheostomy care for clients with new or recent tracheostomy to maintain patency of the tube and minimize the risk for infection (since the inhaled air by the client is no longer filtered by the upper airways). Initially a tracheostomy may need to be suctioned and cleaned as often as every 1 to 2 hours. After the initial inflammatory response subsides, tracheostomy care may only need to be done once or twice a day, depending on the client.

Decannulation: The process whereby a tracheostomy tube is removed once patient no longer needs it.

Humidification: The mechanical process of increasing the water vapour content of an inspired gas.

Stoma: An opening, either natural or surgically created, which connects a portion of the body cavity to the outside environment (in this case, between the trachea and the anterior surface of the neck).

Tracheostomy: A surgical procedure to create an opening between 2-3 (3-4) tracheal rings into the trachea below the larynx.

Tracheal Suctioning: A means of clearing thick mucus and secretions from the trachea and lower airway through the application of negative pressure via a suction catheter.

Tracheostomy tube: A curved hollow tube of rubber or plastic inserted into the tracheostomy stoma (the hole made in the neck and windpipe (Trachea) to relieve airway obstruction, facilitate mechanical ventilation or the removal of tracheal secretions.

Components of Tracheostomy Tube

1. Outer tube
2. Inner tube: Fits snugly into outer tube, can be easily removed for cleaning.
3. Flange: Flat plastic plate attached to outer tube – lies flush against the patient’s neck.
4. 15mm outer diameter termination: Fits all ventilator and respiratory equipment.
5. All remaining features are optional

6. Cuff: Inflatable air reservoir (high volume, low pressure) – helps anchor the tracheostomy tube in place and provides maximum airway sealing with the least amount of local compression.

7. Air inlet valve: One way valve that prevents spontaneous escape of the injected air.
8. Air inlet line: Route for air from air inlet valve to cuff.
9. Pilot cuff: Serves as an indicator of the amount of air in the cuff
10. Fenestration: Hole situated on the curve of the outer tube – used to enhance airflow in and out of the trachea. Single or multiple fenestrations are available.
11. Speaking valve / tracheostomy button or cap: Used to occlude the tracheostomy tube opening

(a) former – during expiration to facilitate speech and swallow,

(b) latter – during both inspiration and expiration prior to decannulation.

Providing Tracheostomy Care Purposes

• To maintain airway patency by removing mucus and encrusted secretions.
• To maintain cleanliness and prevent infection at the tracheostomy site.
• To facilitate healing and prevent skin excoriation around the tracheostomy incision
• To promote comfort
• To prevent displacement

Tracheostomy care involves application of scientific knowledge, sterile technique, and problem solving, and therefore needs to be performed by a nurse or respiratory therapist.

Equipment

• Sterile disposable tracheostomy cleaning kit or supplies (sterile containers, sterile nylon brush or pipe cleaners, sterile applicators, gauze squares)
• Sterile suction catheter kit (suction catheter and sterile container for solution)
• Sterile normal saline (Check agency protocol for soaking solution)
• Sterile gloves (2 pairs)
• Clean gloves
• Towel or drape to protect bed linens
• Moisture-proof bag
• Commercially available tracheostomy dressing or sterile 4-in. x -in. gauze dressing
• Cotton twill ties
• Clean scissors

Procedure

This well-organized, fixed, step-by-step sequence of the whole process of tracheostomy care is taken from Kozier & Erb’s Fundamentals of Nursing.

1. Introduce self and verify the client’s identity using agency protocol. Explain to the client everything that you need to do, why it is necessary, and how can he cooperate. Eye blinking, raising a finger can be a means of communication to indicate pain or distress.

2. Observe appropriate infection control procedures such as hand hygiene.

3. Provide for client privacy.

4. Prepare the client and the equipment.

5. To promote lung expansion, assist the client to semi-Fowler’s or Fowler’s position.

6. Open the tracheostomy kit or sterile basins. Pour the soaking solution and sterile normal saline into separate containers.

7. Establish the sterile field.

8. Open other sterile supplies as needed including sterile applicators, suction kit, and tracheostomy dressing.

9. Suction the tracheostomy tube, if necessary.

Infant and Child

• An assistant may be necessary during tracheostomy care to prevent active children from dislodging or expelling their tracheostomy tubes.
• Always make a sterile, packaged tracheostomy available at bedside for emergency purposes.
• Encourage parents to participate with the procedure in an effort to comfort the child and promote client teaching.
• Care for the skin at the tracheostomy site is important especially for the elders whose skin is more fragile and prone to breakdown.
• Home Care Modifications

Suctioning a Tracheostomy Tube

Suctioning of tracheostomy tube is only done as necessary. Sterile technique must be observed. Nurses should be aware that there is a frequency for the need of suctioning during immediate postoperative period.

Purposes

• Removes thick mucus and secretions from the trachea and lower airway to maintain patent airway and prevent airway obstructions
• To promote respiratory function (optimal exchange of oxygen and carbon dioxide into and out of the lungs)
• To prevent pneumonia that may result from accumulated secretions

Equipment

• Resuscitation bag (Ambu bag) connected to 100% oxygen
• Sterile towel (optional)
• Equipment for suctioning
• Goggles and mask if necessary
• Gown (if necessary) as Sterile gloves
• Moisture-resistant bag
• Preparation

Determine if the client has been suctioned previously and, if so, review the documentation of the procedure. This information can be very helpful in preparing the nurse for both the physiologic and psychologic impact of suctioning on the client

Procedure

This well-organized, fixed, step-by-step sequence of the whole process of tracheostomy suctioning is taken from Kozier & Erb’s Fundamentals of Nursing.

Prior to performing the procedure, introduce self and verify the client’s identity using agency protocol. Explain to the client what you are going to do, why it is necessary, and how he or she can cooperate. Inform the client that suctioning usually causes some intermittent coughing and-that this assists in removing the secretions.