Speaker : ZayChung

Venue: Coronary Care Department

Time : 0730-0830hrs
Date : 2008
1. Nurses Aware of the management of
patient with tracheostomy

3. Prevent Complication
1. A Tracheostomy is a Surgical incision
made between the second and third
tracheal rings.

3. Then a cuffed tracheostomy tube of

an appropriate size is inserted, for the
purpose of establishing an airway
1. Bypass an Upper Airway Obstruction
2. Facilitate removal of secretion
3. Permit long-term mechanical
ventilation
4. Permit oral intake and speech in the
patient who requires long-term
mechanical ventilation
1.Temporary:
**Elective Procedure
E.g.: Followed by major surgery like
partial glossectomy
2. Permanent:
**Tracheostomy follow a total laryngectomy
or unable to wean off intubations
3. Emergency:
**Perform as an emergency when patient has
an
obstruction airway condition
E.g:Poisoning (Corrosives)
1. Portex Cuffed Tracheostomy Tube
- available with inner / without inner
cannula
- plastic
- inflatable cuff
- give airtight seal
2 . Shiley Plain Tracheostomy Tube
- plastic
- comes with introducer and 2 inner
tubes
- facilitates connection to other
equipment
E.g.: Speaking Valves
3 . Shiley Fenestrated Tube
- plastic
- with introducer
- two inner tube – one with extension
4 . Shiley Cuffed Fenestrated Tube
- plastic
- with introducer
- two inner tube
Sterile technique is to be followed throughout
Procedure
• Gather Supplies
• Explain procedure
• Wash hand
• Prepare equipment
• Put on sterile gloves
• Remove sterile suction catheter from package
7. Lubricate tip of catheter by dipping tip in
sterile saline
3. Pre-Oxygenate patient prior suctioning
4. Disconnect from the supplementary
oxygen source
10. If patient is cooperative, ask him / her to
take deep breath and quickly but gently
insert the catheter into the trachea.
If resistance is felt withdraw the catheter
slightly. (The catheter control valve is left
open or not depressed during insertion, so
that no suction is applied during insertion)
11. Apply intermittent suction.
Rotate the catheter between your thumb
forefinger during withdrawal of catheter

12. As soon as the catheter withdrawn ,

re-connect to the ventilator or oxygen
supply source.
Re-oxygenate the patient

13. Clear the Catheter with saline

14. Repeat the procedure if necessary
Note:
The Suction procedure should not take any
Longer that 15sec from insertion to completion
Of withdrawals of catheter.
Supplies

1. Sterile dressing pack

2. Tracheostomy dressing / keyhole
3. Solution (Saline)
4. Tracheostomy tape / tie
1. Explain to patient the procedure
2. Privacy (Screen the area / Bed)
3. Wash hand
4. Perform the procedure under aseptic
technique
6. Remove the soiled dressing
7. Clean trache stoma area with saline
8. Replaced with tracheostomy
dressing/keyhole
9. Re-new the tracheostomy tapes/tie
(Checked that one finger can be placed
between the tapes/tie and neck)
• Small brush or pipe
cleaners
• Half strength
solution
of hydrogen
peroxide
• Saline 0.9%
• Two small Bowl
(Kidney basin)
1. Wash hand
2. Place ½ strength hydrogen peroxide in
one bowl and sterile saline in 2nd bowl
4. Remove the inner cannula while holding
the next plate of the trach still..
6. Place the inner cannula in peroxide
solution and sock until crusts are soften
or removed
8. Use the brush or pipe cleaner to clean the
inside, outside and creases of the tube
9. Look inside the inner cannula to make sure
it is clean and clear of mucus
1. Rinse tube in saline water
2. Reinsert it while holding the neck
plate of the trach still..
3. Turn the inner cannula until it locks
into position
4. Double check the locking by pulling
forward gently on the inner cannula
5. Kept the clean trach tube in a proper
place.
1. Infection
2. Dysphagia
3. Obstruction from accumulation of
secretions
4. Aspiration
5. Tracheal dilation, ischemia & Necrosis
• Bleeding
• Pneumothorax
• Air Embolism
• Subcutaneous or Mediastinal emphysema
• Recurrent laryngeal nerve damage
• Posterior tracheal wall penetration
• Rupture of the innominate artery
• Tracheoesophageal fistula
 Yesterday is a
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Tomorrow is a
Promissory Note
Today is
Ready Cash…Use It

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