CARE OF THE PATIENT WITH A TRACHEOSTOMY SHARON HARVEY 24/05/04.

CARE OF THE PATIENT CARE OF THE PATIENT WITH A TRACHEOSTOMYWITH A TRACHEOSTOMY

SHARON HARVEYSHARON HARVEY

24/05/0424/05/04

LEARNING OUTCOMESLEARNING OUTCOMES

THE STUDENT WILL BE ABLE TO:THE STUDENT WILL BE ABLE TO: Provide a definition of a tracheostomyProvide a definition of a tracheostomy Apply the A & P knowledge to the care of the patient Apply the A & P knowledge to the care of the patient

with a tracheostomywith a tracheostomy State the indications for a person requiring a State the indications for a person requiring a

tracheostomytracheostomy State the different techniques used to form a State the different techniques used to form a

tracheostomytracheostomy Recognise the different components of the Recognise the different components of the

tracheostomy tubetracheostomy tube Identify the complications of a tracheostomyIdentify the complications of a tracheostomy

RESPIRATIONRESPIRATION

IS THE EXCHANGE OF OXYGEN AND IS THE EXCHANGE OF OXYGEN AND CARBON DIOXIDE BETWEEN THE CARBON DIOXIDE BETWEEN THE ATMOSPHERE AND THE BODY ATMOSPHERE AND THE BODY CELLS.CELLS.

RESPIRATION INVOLVESRESPIRATION INVOLVES

VENTILATION, THE MOVEMENT OF AIR VENTILATION, THE MOVEMENT OF AIR INTO AND OUT OF THE RESPIRATORY INTO AND OUT OF THE RESPIRATORY PASSAGES AND THE LUNGSPASSAGES AND THE LUNGS

GAS EXCHANGE BETWEEN THE AIR IN THE GAS EXCHANGE BETWEEN THE AIR IN THE LUNGS AND THE BLOODLUNGS AND THE BLOOD

TRANSPORT OF OXYGEN AND CARBON TRANSPORT OF OXYGEN AND CARBON DIOXIDE IN THE BLOODDIOXIDE IN THE BLOOD

GAS EXCHANGE BETWEEN THE BLOOD GAS EXCHANGE BETWEEN THE BLOOD AND THE TISSUESAND THE TISSUES

WHAT IS A WHAT IS A TRACHEOSTOMY?TRACHEOSTOMY?

A tracheostomy is a surgical opening A tracheostomy is a surgical opening in the anterior wall of the trachea in the anterior wall of the trachea just below the larynx.just below the larynx.

It provides an alternative airway, It provides an alternative airway, bypassing the upper passages.bypassing the upper passages.

TYPES OF TRACHEOSTOMYTYPES OF TRACHEOSTOMY

TemporaryTemporary PermanentPermanent EmergencyEmergency SurgicalSurgical PercutaneousPercutaneous MinitracheostomyMinitracheostomy CricothyroidotomyCricothyroidotomy

TRACHEOSTOMY TUBESTRACHEOSTOMY TUBES

A tracheostomy A tracheostomy tube is:-tube is:- Inserted through Inserted through

the tracheostomy to the tracheostomy to maintain a patent maintain a patent airwayairway

Secured in place by Secured in place by tapes tied around tapes tied around the neckthe neck

INDICATIONSINDICATIONS

To provide and maintain a patent airwayTo provide and maintain a patent airway To enable the removal of To enable the removal of

tracheobronchial secretionstracheobronchial secretions To permit long term positive pressure To permit long term positive pressure

ventilationventilation To improve patient comfortTo improve patient comfort To decrease the work of breathing and To decrease the work of breathing and

increase volume of air entering the lungsincrease volume of air entering the lungs

TYPES OF TRACHEOSTOMY TYPES OF TRACHEOSTOMY TUBETUBE

UncuffedUncuffed

TYPES OF TRACHEOSTOMY TYPES OF TRACHEOSTOMY TUBETUBE

CuffedCuffed

TYPES OF TRACHEOSTOMY TYPES OF TRACHEOSTOMY TUBETUBE

FenestratedFenestrated

ANATOMICAL POSITIONING OF A TRACHEOSTOMY TUBE

PERCUTANEOUS TRACHEOSTOMY INSERTION KIT (RHINO)

PERCUTANEOUS TRACHEOSTOMY KIT

COMPONENTS OF COMPONENTS OF TRACHEOSTOMYTRACHEOSTOMY

SIZES RANGE SIZES RANGE FROM 2.5MM TO FROM 2.5MM TO 11 MM11 MM

CURVED TUBECURVED TUBE INFLATABLE CUFFINFLATABLE CUFF FLANGES WITH FLANGES WITH

HOLESHOLES TUBE BLADDERTUBE BLADDER

PERI-OPERATIVE PERI-OPERATIVE COMPLICATIONS OF COMPLICATIONS OF

TRACHEOSTOMYTRACHEOSTOMY HAEMORRHAGEHAEMORRHAGE SURGICAL SURGICAL

EMPHYSEMAEMPHYSEMA PNEUMOTHORAXPNEUMOTHORAX AIR EMBOLISMAIR EMBOLISM CRICOID CRICOID

CARTILAGE CARTILAGE DAMAGEDAMAGE

NERVE DAMAGENERVE DAMAGE

COMPLICATIONS ASSOCIATED COMPLICATIONS ASSOCIATED WITH TRACHEOSTOMY TUBE WITH TRACHEOSTOMY TUBE

PLACEMENTPLACEMENT TRACHEAL STENOSIS, TRACHEAL STENOSIS,

ULCERATION, FIBROSIS, ULCERATION, FIBROSIS, TRACHEOMALACIATRACHEOMALACIA

LOSS OF NORMAL LOSS OF NORMAL HUMIDIFYING AND HUMIDIFYING AND WARMING MECHANISMSWARMING MECHANISMS

LOSS OF PHYSIOLOGICAL LOSS OF PHYSIOLOGICAL PEEPPEEP

INCREASED RISK OF INCREASED RISK OF NOSOCOMIAL PNEUMONIANOSOCOMIAL PNEUMONIA

CARING FOR THE PATIENTCARING FOR THE PATIENT

Having a tracheostomy can be very Having a tracheostomy can be very traumatic and many patients find it traumatic and many patients find it difficult to adjust.difficult to adjust.

Patients with a new tracheostomy Patients with a new tracheostomy will need lots of support, reassurance will need lots of support, reassurance and educationand education

CARE OF THE PATIENT WITH A CARE OF THE PATIENT WITH A TRACHEOSTOMYTRACHEOSTOMY

SAFETY FIRSTSAFETY FIRST CARE OF THE STOMACARE OF THE STOMA COMMUNICATIONCOMMUNICATION PSYCHOLOGICALPSYCHOLOGICAL NUTRITIONNUTRITION INFECTION CONTROLINFECTION CONTROL

SAFETY FIRSTSAFETY FIRSTWHEN CARING FOR A PATIENT WITH A WHEN CARING FOR A PATIENT WITH A

TRACHEOSTOMY YOU MUST ENSURE THAT:-TRACHEOSTOMY YOU MUST ENSURE THAT:-

THERE ARE SPARE TRACHEOSTOMIES THERE ARE SPARE TRACHEOSTOMIES AVAILABLE CLOSE BY 1 THE SAME SIZE AVAILABLE CLOSE BY 1 THE SAME SIZE AND THE OTHER A SIZE SMALLERAND THE OTHER A SIZE SMALLER

A TRACHEAL DILITATION KIT IS CLOSE A TRACHEAL DILITATION KIT IS CLOSE BYBY

SUCTION EQUIPMENT IS AVAILABLESUCTION EQUIPMENT IS AVAILABLE DIFFERENT SIZE SUCTION CATHETERS DIFFERENT SIZE SUCTION CATHETERS

AVAILABLEAVAILABLE OXYGEN IS AVAILABLEOXYGEN IS AVAILABLE EMERGENCY EQUIPMENT IS AVAILABLE EMERGENCY EQUIPMENT IS AVAILABLE

INCLUDING A RESUSCITATION BAG AND INCLUDING A RESUSCITATION BAG AND MASK AND DEFIBRILLATOR AND MASK AND DEFIBRILLATOR AND EMERGENCY DRUGSEMERGENCY DRUGS

CARE OF THE STOMA / CARE OF THE STOMA / INFECTION CONTROLINFECTION CONTROL

THE STOMA HAS TO BE THE STOMA HAS TO BE CARED FOR CAREFULLYCARED FOR CAREFULLY

IT NEEDS TO BE CLEANED IT NEEDS TO BE CLEANED AND INSPECTED 2-3 AND INSPECTED 2-3 TIMES A DAYTIMES A DAY

IT SHOULD BE CLEANED IT SHOULD BE CLEANED USING ASEPTIC USING ASEPTIC TECHNIQUE AND TECHNIQUE AND APPROPRIATE DRESSINGS APPROPRIATE DRESSINGS APPLIED TO AID HEALINGAPPLIED TO AID HEALING

ONCE TUBE IS REMOVED ONCE TUBE IS REMOVED THE STOMA WILL CLOSE THE STOMA WILL CLOSE SPONTANEOUSLY OVER A SPONTANEOUSLY OVER A FEW DAYSFEW DAYS

PSYCHOLOGICAL / PSYCHOLOGICAL / COMMUNICATIONCOMMUNICATION

PATIENTS AND FAMILY PATIENTS AND FAMILY REQUIRE REASSURANCE AND REQUIRE REASSURANCE AND SUPPORTSUPPORT

ALTERNATIVE METHODS OF ALTERNATIVE METHODS OF COMMUNICATION SHOULD COMMUNICATION SHOULD BE SOUGHTBE SOUGHT

CONTACT S.A.L.T FOR CONTACT S.A.L.T FOR ADVICE ON COMMUNICATIONADVICE ON COMMUNICATION

PROVIDE STIMULATION IN PROVIDE STIMULATION IN THE FORM OF TELEVISION, THE FORM OF TELEVISION, RADIO, NEWSPAPERS, ETCRADIO, NEWSPAPERS, ETC

NUTRITIONNUTRITION

CHECK LOCAL POLICY ON EATING AND CHECK LOCAL POLICY ON EATING AND DRINKING WITH TRACHEOSTOMIESDRINKING WITH TRACHEOSTOMIES

SOME TRUSTS ALLOW PATIENTS TO EAT SOME TRUSTS ALLOW PATIENTS TO EAT AND DRINKAND DRINK

OTHERS DO NOT!!OTHERS DO NOT!! USUAL WAYS OF FEEDING INCLUDE USUAL WAYS OF FEEDING INCLUDE

ORAL, NASOGASTRIC OR PARENTERAL.ORAL, NASOGASTRIC OR PARENTERAL.

SUMMARYSUMMARY

PATIENTS WITH TRACHEOSTOMIES PATIENTS WITH TRACHEOSTOMIES CAN BE FOUND IN MANY HEALTH CAN BE FOUND IN MANY HEALTH CARE ENVIRONMENTS FROM CARE ENVIRONMENTS FROM INTENSIVE CARE/HIGH DEPENDENCY INTENSIVE CARE/HIGH DEPENDENCY TO THE COMMUNITYTO THE COMMUNITY

CARING FOR PATIENTS WITH CARING FOR PATIENTS WITH TRACHEOSTOMIES CAN BE DIFFICULT TRACHEOSTOMIES CAN BE DIFFICULT BUT REWARDINGBUT REWARDING