Tracheostomy Care (1)

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School

St. Clair College *

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MISC

Subject

Mechanical Engineering

Date

Oct 30, 2023

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docx

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Uploaded by AgentScorpionMaster2905

Tracheostomy Care Various Tubes- nasal/oral Various Tubes-endotracheal/trach A tracheostomy tube is needed for patients:  undergoing prolonged mechanical ventilation  upper airway obstructions secondary to  tumors  difficulties with airway clearance as a result of spinal cord injuries or neuromuscular disease Advantages of tracheostomy  Decrease risk of tissue injury  Access for oral hygiene  Long term or permanently  Easily replaced if damaged/dislodged  Family/patient can care for the tracheostomy tube  May be able to cough secretions out of trach tube independently Trach Tube Tracheostomy Assessment  Assess for: v Soiled or loose ties or dressing v Nonstable tube v Excessive secretions, skin assessment v Assess for signs and symptoms of upper and lower airway obstruction: Assess for signs and symptoms of upper and lower airway obstruction requiring nasotracheal or orotracheal suctioning, abnormal respiratory rate, adventitious sounds, nasal secretions, gurgling, drooling, restlessness, gastric secretions, or vomitus in mouth, and coughing without clearing secretions from airway. Objective exam v Assess signs and symptoms associated with hypoxia and hypercapnia: Assess signs and symptoms associated with hypoxia and hypercapnia: decreased SpO2, increased pulse and blood pressure, increased respiratory rate, apprehension, anxiety, decreased ability to concentrate, lethargy, decreased level of consciousness (especially acute), increased fatigue, dizziness, behavioural changes (especially irritability), dysrhythmias, pallor, and cyanosis.  Objective exam v Vital signs- oxygen saturation, respiratory rate and effort v Lung sounds and patient’s ability to cough Tracheostomy Safety  Make sure there is always • Suction

• Tracheostomy obturator • Tracheostomy tube at the bedside in case of dislodged tube TRACHEOSTOMY SUCTIONING  Follow facility policy- sterile vs clean technique.  Donne PPE as needed- gloves, gown, mask, goggles/shield  Connect catheter to suction per policy (less than 150mmhg in adults)  Lubricate catheter by suctioning a small amount of sterile normal saline or water (per policy)  Provide supplemental oxygen before and after each suctioning attempt  Without applying suction, gently but quickly insert catheter using dominant thumb and forefinger into artificial airway (insertion with inspiration) until resistance is met or patient coughs, then pull back 1 cm  Intermittent suction for no longer than 10 seconds- placing and releasing nondominant thumb over vent of catheter  Slowly withdraw catheter while rotating it back and forth between dominant thumb and forefinger  Encourage patient to cough. Watch for respiratory distress.  Wait 1 full minute between attempts - 3 attempts  Assess your patient's respiratory status before, during, and after care

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