A TRACHEOSTOMY is an opening in the anterior wall of the trachea inferior to the cricoid process. Made surgically or percutaneously, it provides tracheal access for airway management via a temporary or permanent tracheostomy tube.
When does a patient need tracheostomy?
A tracheostomy can be used to bypass an acute or chronic upper airway obstruction, allow removal of tracheobronchial secretions, and prevent aspiration of oral or gastric secretions in unresponsive patients. For patients with chronic respiratory failure or failure to wean from ventilator, it may be performed to replace an endotracheal (ET) tube and facilitate long-term mechanical ventilation. In most cases, patients who have been on mechanical ventilation for over 14 days may be indicated for tracheostomy primarily to prevent secondary complication like ventilator associated pneumonia (VAP).
What may cause upper airway obstructions?
Upper airway obstruction can result from conditions such as tumors, inflammation, fracture, foreign bodies, angioedema or laryngeal spasm. Patients with prolonged unresponsiveness secondary to such conditions, as drug intoxication or traumatic brain injury may need a tracheostomy to maintain a patent airway.
Complication of Tracheostomies
Early complications associated with Surgical Tracheostomy include: –
- Air embolism
- Recurrent laryngeal nerve damage
- Posterior tracheal wall injury.
Long-term complications include: –
- Airway obstruction from accumulation of secretions or protrusion of the cuff over the opening of the tube
- Rupture of the innominate artery
- Tracheoesophageal fistula
- Tracheal dilation
- Tracheal ischemia and necrosis.
Taking Care of Tracheostomy
Although details vary depending on the type of tracheostomy tube, tracheostomy care includes cleaning or changing the inner cannula, changing the dressing and tracheostomy tube holder, and suctioning if needed. Most tracheostomy tubes have disposable inner cannulas, which are replaced and secured using aseptic technique. Never clean and reuse a disposable cannula.
If your patient has a reusable inner cannula, use this guide to clean an inner cannula.
Tracheostomy Suctioning tips
Because the patient cannot cough effectively to clear secretions, be prepared to suction your patient as needed. Suctioning raises the risk of hypoxemia, bronchospasm, and other adverse reactions, so suction only when needed, not on a set schedule, and suction for the shortest time necessary to clear secretions. Indications for suctioning include coughing, secretions in the airway, respiratory distress, presence of rhonchi on auscultation, increased peak airway pressures on the ventilator, and decreasing SaO2 or PaO2.
If uncomfortable or unsure about how to take care of a patient with a tracheostomy, refer to your unit specific policy and procedure manuals usually located in the nurses’ station or your facility intranet.