Tracheostomy is a surgical procedure for the trachea, which, in common words, is known as the windpipe. While surgery is not critical, post-surgical care is of extreme importance. Expert care of a patient with tracheostomy is necessary to prevent infection, maintain the airway, and provide comfort to the patient.
Tracheostomy involves inserting a tube into the trachea for replacement support in cases where the patient’s windpipe has issues. For example, a blocked airway or an impaired windpipe. The tube gives the patient a clear windpipe that helps with normal breathing. The surgery involves creating an opening in the neck for the tube insertion. Below, we will understand the tracheostomy care nursing procedure, essential nursing interventions, and an ideal tracheostomy nursing care plan for patients undergoing tracheostomy.
Care Of Patient With Tracheostomy
A patient with a tracheostomy needs to be given special nursing attention after the procedure. Here is a list of things nursing care does for tracheostomy patients:
- Prevent infection at the site
- Ensure that the tube is free from blockages and functioning
- Monitor the oxygen levels and provide oxygen and ventilation if needed
- Support communication
- Fulfill nutritional needs
- Monitor 24/7 for post-surgery complications
More than the surgery, tracheostomy patients require post-operative care and nursing to monitor and prevent complications. Detecting early signs of infection, obstruction, or discomfort is critical in the process; hence, nurses play a crucial role. Tracheostomy is done on patients with critical medical conditions such as respiratory failure, neurological disorders, or prolonged mechanical ventilation needs.
Tracheostomy Care Nursing Procedure
A trained and special nurse for tracheostomy care nursing is needed to ensure sterility and patient safety after the procedure:
1. Preparing for Tracheostomy Care
Tracheostomy care requires several medical supplies. The nurse requires the following:
- Gloves
- Saline water
- Cotton and Applicators
- Gauze pads
- Tracheostomy ties or Velcro fasteners
- Suction catheter
- Clean inner cannula (if applicable)
- Hydrogen peroxide (if required)
2. Suctioning the Tracheostomy Tube
The tracheostomy tube needs to be suctioned regularly to ensure it is clean and free of obstructions. The suctioning removes mucus and secretions from the tube airway to prevent infections. Suctioning process-
- The nurse wears sterile gloves after washing hands.
- The suction catheter is attached to the suction machine.
- Then, the catheter is inserted into the tracheostomy tube without suction.
- Suction is applied while slowly withdrawing the catheter.
- The process is repeated based on the requirement, giving the patient breaks in between to rest.
Suctioning is only done when needed. The signs of a buildup or secretions include audible breathing, visible mucus, difficulty in breathing and/or low oxygen levels.
3. Cleaning the Inner Cannula
If the tube added through a tracheostomy has an inner cannula, it requires regular cleaning to prevent infection and smooth respiratory operations. Here’s the process-
- A nurse removes the inner cannula, wearing sterile gloves.
- The inner cannula is soaked in sterile saline or hydrogen peroxide.
- It is scrubbed with a brush to remove all the buildup and mucus.
- Then, it is rinsed and dried before being inserted again into the trachea.
4. Cleaning the Stoma Site
The area surrounding the tube is called the stoma. It should be kept clean to prevent infections.
- Cotton-tipped applicators dipped in sterile saline are used to clean the stoma.
- Then, the area is patted dry with sterile gauze.
- Then, a fresh dressing is done at the site.
Hygiene reduces the risk of infections, irritation, and skin breakdown. Signs of redness, swelling, or unusual discharge are signs of infection, which need immediate attention from the doctor.
5. Securing the Tracheostomy Tube
Nurses ensure that the tube is secured properly and prevent dislodgment. Loose tubes can cause dislodgment and medical emergencies. When properly tied, the tube becomes stable and gives the patient comfort.
- Soiled or loose ties are replaced.
- The tracheostomy ties should comfortably fit with space for two fingers under them.
Tracheostomy Nursing Care Plan
Nurses and health care professionals follow a structured tracheostomy nursing care plan for post-operative care. It includes assessments, interventions, and expected outcomes.
| Nursing Diagnosis for Tracheostomy | Nursing Interventions | Expected Outcomes |
| Risk of infection | Maintain a sterile environment, and clean the stoma regularly | Reduced risk of infection |
| Impaired communication | Provide alternative communication methods | Effective patient interaction |
| Risk of airway obstruction | Perform suctioning as needed | Clear airway and effective breathing |
| Impaired nutrition | Assess swallowing ability, provide enteral feeding if needed | Adequate nutrition and hydration |
Additional Nursing Considerations When Taking Care Of Patient With Tracheostomy
Nurses play an important role in the post-operative care of a tracheostomy patient. While we have covered the nursing care procedure, here are a few other things that come under their responsibilities-
- Monitor Oxygen Levels: The oxygen levels indicate if any blockage or buildup is forming in the tube. The oxygen saturation levels ensure that the patient is getting adequate ventilation.
- Watch for Complications: Signs of complications such as itching, bleeding, audible breathing, and dislodgment need to be monitored.
- Pulmonary Hygiene: The patient needs to learn and follow pulmonary hygiene to aid with respiration. It includes deep-breathing exercises, coughing techniques, and postural drainage.
- Emotional Support: Patients often feel demotivated and develop anxiety or depression due to continuous or serious health issues. Reassurance and motivation at the correct time can help the patients feel better and motivated to get better.
Nursing Diagnosis for Tracheostomy
While we know the responsibilities of nurses, here are the most common diagnoses that indicate complications. Nursing Diagnosis for Tracheostomy-
- Ineffective Airway Clearance is caused by mucus buildup in the tracheostomy tube.
- Risk for infection caused by an open airway and tracheostomy stoma.
- Impaired Verbal Communication due to the inability to vocalise with a tracheostomy tube.
- Risk for Aspiration in patients having difficulty in swallowing.
Care Of Patient With Tracheostomy at Olive Elder Care
After covering everything about tracheostomy nursing care, one thing is established: a patient with tracheostomy cannot be taken care of at home by family. It requires expert supervision and trained hands to take care of the patient. At Olive Elder Care, we have residential programs for critical patients who need 24/7 supervision and medical care from trained and experienced healthcare providers. Alternatively, we also provide home care services, such as medical support for patients who are more comfortable living at home.
However, at Olive Elder Care, we provide the best nursing care for tracheostomy and focus on holistic wellness for overall health and well-being. The combined approach aids in improving the health of the patients and faster healing. Our care program includes attention to nutrition, fitness, emotional health, medical care, security, community living, and recreation for the complete wellness of our residents.
Get in touch with us today if you know someone who needs critical care attention for any medical condition, including tracheostomy care.
Frequently Asked Questions
1. How do you take care of a tracheostomy patient?
Caring for tracheostomy patients involves monitoring for complications, regularly cleaning the stoma, suctioning the trachea if needed, looking for signs of infections, and aiding with communication and proper respiration.
2. How to talk with a tracheostomy?
Patients with tracheostomy can use sign language, electronic devices, writing boards, or a speaking valve. Some patients may also be able to speak again with speech therapy and airway management.
3. Does tracheostomy need a ventilator?
Tracheostomy patients may or may not need a ventilator. It depends on their medical condition and their ability to breathe independently. In some cases, they might need it.
4. Can patients eat with a tracheostomy?
Swallowing can be difficult for tracheostomy patients. Hence, they are monitored. Depending on their comfort and ability, a doctor can advise them to adopt modified diets (liquid or paste for smooth swallowing) or enteral feeding.
