Tracheostomy Care Nursing Procedure

A tracheostomy is a medical procedure where an opening is created in the neck to allow direct access to the trachea (windpipe) for breathing. A tube is inserted into the opening to assist with airway management in patients who have difficulty breathing due to various medical conditions, including respiratory failure, chronic obstructive pulmonary disease (COPD), neurological disorders, or after extensive surgeries.

Providing proper tracheostomy care is essential to prevent complications such as infection, blockage, and dislodgment of the tube, as well as to promote patient comfort and safety. Nurses play a vital role in ensuring that tracheostomy care is performed with the necessary skill, knowledge, and vigilance.

Objectives of Tracheostomy Care

The goals of tracheostomy care include:

• Preventing infection: The tracheostomy tube and surrounding tissue are prone to bacterial growth.

• Clearing airway obstructions: Secretions and mucus must be regularly removed to ensure the airway remains patent.

• Maintaining tube stability: The tracheostomy tube must remain securely in place.

• Promoting comfort: Proper care minimizes discomfort for the patient and helps maintain normal respiratory function.

• Ensuring patient and family education: Teaching proper care techniques helps empower the patient and family in managing the tracheostomy.

  
  

Nursing Procedure for Tracheostomy Care

The nursing procedure for tracheostomy care involves several steps, each designed to ensure the safety and comfort of the patient while preventing complications.

Step 1: Gather Necessary Supplies

Before performing the procedure, ensure you have all necessary materials:

• Sterile gloves

• Clean or sterile tracheostomy tube (if a replacement is needed)

• Suction catheter and suction machine

• Sterile saline or sterile water

• 4x4 gauze pads

• Clean, dry cloths or towels

• Tracheostomy cleaning kit (if applicable)

• Water-soluble lubricant (if required)

• Hydrogen peroxide or normal saline for cleaning the site

• O2 therapy equipment (in case of desaturation)

• Spare tracheostomy tube of the same size (for emergencies)

  
  

Step 2: Wash Hands and Prepare the Environment

• Wash your hands thoroughly to prevent contamination.

• Position the patient in a comfortable, semi-sitting position (if possible), ensuring access to the tracheostomy site. If the patient is unable to sit, place them in a side-lying or supine position with the head slightly elevated.

• Ensure that the room is well-lit and free from distractions.

  
  

Step 3: Assess the Patient

• Check the patient's respiratory status: Listen to lung sounds, monitor oxygen saturation, respiratory rate, and check for signs of airway distress, such as labored breathing or tachypnea.

• Assess the tracheostomy tube and stoma site: Ensure the tube is properly positioned, and check for signs of infection (redness, drainage, swelling) or irritation around the stoma.

• Verify that suction equipment is functional and that the necessary supplies are ready.

  
  

Step 4: Perform Suctioning (If Needed)

• Suctioning is necessary to clear the airway of secretions, particularly if the patient is unable to expectorate.

1. Don sterile gloves.

2. Connect the suction catheter to the suction machine.

3. Pre-oxygenate the patient if necessary by providing supplemental oxygen.

4. Insert the catheter gently into the tracheostomy tube, using a sterile technique, and suction for 5–10 seconds while rotating the catheter.

5. Assess the secretions and the patient’s response to suctioning. If necessary, suction multiple times with breaks in between to allow the patient to recover.

6. Reassess the patient's oxygen saturation and respiratory rate after suctioning.

   
   

Step 5: Remove and Clean the Tracheostomy Tube

• Remove the tracheostomy tube for cleaning if necessary (especially if the tube has been in place for a while or if there is visible buildup).

1. Unlock the tube's inner cannula (if it has one) and remove it.

2. Clean the inner cannula using hydrogen peroxide or sterile saline to remove mucus and debris. Use a brush if provided by the manufacturer.

3. Rinse with sterile saline to remove all cleaning solution.

4. Reinsert the inner cannula into the outer tube once clean.

   
   

Step 6: Clean the Stoma Site

• Remove any crusting or dried secretions from around the stoma site using sterile saline or hydrogen peroxide.

• Inspect the stoma for any signs of infection (e.g., redness, swelling, excessive drainage).

• Gently cleanse the skin around the stoma with a gauze pad soaked in saline, hydrogen peroxide, or a tracheostomy cleaning solution.

• Dry the area thoroughly with a clean gauze pad to prevent moisture buildup.

  
  

Step 7: Replace the Tracheostomy Tube (If Necessary)

• Place a new sterile tracheostomy tube if required, ensuring that the size of the new tube matches the old one.

1. Lubricate the tube (if required) with a water-soluble lubricant to facilitate insertion.

2. Insert the tube carefully into the stoma, ensuring it fits securely.

3. Secure the tube with the tracheostomy ties around the neck or use a flange to secure the tube in place.

   
   

Step 8: Reassess the Patient’s Respiratory Status

• Once the tube is securely in place, reassess the patient’s respiratory status. Monitor:

• Oxygen saturation levels (pulse oximeter).

• Breath sounds (auscultate lung fields).

• Respiratory rate.

• Patient's comfort level.

• Adjust oxygen therapy if needed to ensure optimal respiratory function.

  
  

Step 9: Dispose of Used Materials

• Dispose of gloves, gauze, and any used equipment in an appropriate waste bin.

• Ensure that the work area is cleaned, and all supplies are accounted for.

  
  

Step 10: Document the Procedure

• Document the procedure in the patient's chart, including:

• The patient's condition before and after the procedure.

• The presence of secretions, suctioning performed, and any difficulty encountered.

• Any signs of infection or complications at the tracheostomy site.

• Any changes in the patient’s respiratory status.

• The appearance and condition of the tracheostomy tube, and whether it was replaced or cleaned.

  
  

Key Points for Tracheostomy Care

• Infection Prevention: Always use sterile techniques when cleaning the tracheostomy tube or working around the stoma site. Keeping the area dry and clean is crucial to prevent infections.

• Patient Comfort: Tracheostomy care can be uncomfortable for patients, so it is important to monitor their comfort and reassure them during the procedure.

• Regular Monitoring: Regular assessments of the tube and stoma are important to detect early signs of complications such as infection, blockage, or dislodgement.

• Emergency Preparedness: Always have a spare tracheostomy tube (of the same size) available in case of accidental dislodgement. Know the steps to take if the tube becomes dislodged or if the patient experiences respiratory distress.

  
  

Conclusion

Tracheostomy care is a critical aspect of nursing practice, requiring knowledge, skill, and attention to detail. Through a meticulous and thorough procedure, nurses help maintain the patient’s airway, prevent complications, and improve overall respiratory function. By adhering to proper tracheostomy care techniques, healthcare providers can ensure that patients receive optimal care and experience minimal discomfort while also enhancing their safety and quality of life. Regular training and awareness of best practices in tracheostomy care are essential for nursing professionals working with these patients.