Trachs & Chest Tubes 12/1 Chapter 21

Tracheostomy: surgical incision to the trachea. Purpose is to establish an airway. o Tracheostomy: stoma (opening) that results from tracheotomy. Can be temporary or permanent. o Ventilation, Airway protection, Airway obstruction, Secretions Tracheostomy Tubes o Disposable /reusable o Cuffed tube or tube without cuff for airway maintenance o Inner cannula disposable or reusable o Fenestrated tube Feature Present Absent Inner Cannula (a removable inner tube within an outer tracheostomy tube) Double lumen tubes have both inner and outer cannulas; inner one can be removed for cleaning, and may be reusable or disposable Single-lumen tubes have no inner cannula and may be used short term or in clients not anticipated to have copious respiratory secretions Cuff (a balloon that seals airway) Cuffed prevents air loss during mechanical ventilation and prevents aspiration of saliva gastric contents, or lube feedings; is inflated with air using a syringe attached to the pilot balloon Cuffless tube is often selected for long-term use in clients who do not need mechanical ventilation and are at low risk of aspiration Fenestration (holes to allow air flow between larynx and trachea) Fenestrated trach is used frequently during weaning, so client regains ability to breathe naturally; is allows client to speak Nonfenestrated traches have no holes and are ideal for clients on mechanical ventilation who cannot speak Nursing Care for the patient with a Tracheostomy: o Assess the patient o Secure tracheostomy tubes in place o Prevent accidental decannulation o Prevent tissue damage o Cuff pressure can cause mucosal ischemia. o Use minimal leak and occlusive techniques (make sure cuff is inflated) o Check cuff pressure often o Prevent tube friction and movement o Prevent/treat malnutrition, hemodynamic instability, hypoxia (find way to give them nutrition) o Change inner cannula (per institutional guidelines). This is sterile technique. o Stoma care o Change trach ties (Velcro that surrounds the neck. Change as needed) o Mobilize secretions o Assess for possible complications (Tube obstruction/dislodgement) o Magic slate (use for communication) – board where they can point or write Nursing Care/Knowledge Tracheostomy o Air warming and humidification (respiratory therapy does this) o Tracheostomy tube bypasses nose and mouth (this usually warms the air for us), which normally humidify, warm, and filter air o Air must be humidified o Maintain proper temperature o Ensure adequate hydration Suctioning Trach o Maintains patent airway, promotes gas exchange o Assess the need in patients who cannot cough adequately o Done through nose or mouth Complications of Suctioning o Hypoxia – preoxygenate with 100% oxygen o Tissue (mucosal) trauma- suctioning can cause damage o Infection- (trach branch is sterile and we must maintain sterile technique) o Vagal stimulation, bronchospasm o Cardiac dysrhythmias from induced hypoxia