patient with tracheostomy tube report sample

How to care for a patient with a tracheostomy?

• Wash your hands thoroughly with soap and water.
• Stand or sit in a comfortable position in front of a mirror (in the bathroom over the sink is a good place to care for your trach tube).
• Put on the gloves.
• Suction the trach tube. ...
• If your tube has an inner cannula, remove it. ...

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Why would someone need a tracheostomy?

• Need for prolonged respiratory support, such as Bronchopulmonary Dysplasia (BPD)
• Chronic pulmonary disease to reduce anatomic dead space
• Chest wall injury
• Diaphragm dysfunction

How to take care of tracheostomy patients?

Providing Tracheostomy Care

• To maintain airway patency by removing mucus and encrusted secretions.
• To maintain cleanliness and prevent infection at the tracheostomy site
• To facilitate healing and prevent skin excoriation around the tracheostomy incision
• To promote comfort
• To prevent displacement

When to change a tracheostomy tube?

• The patient's airway should be cleared by coughing or suctioning prior to changing the tracheostomy tube.
• The obturator is to remain with the patient at all times.
• A second complete sterile tracheostomy tube of the same size should be readily available.

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How do you document a tracheostomy care?

Checklist for Tracheostomy Care With a Reusable Inner CannulaPerform hand hygiene.Check the room for transmission-based precautions.Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.Confirm patient ID using two patient identifiers (e.g., name and date of birth).More items...

How do you assess a patient with a tracheostomy?

AssessmentRespiratory status (ease of breathing, rate, rhythm, depth, lung sounds, and oxygen saturation level)Pulse rate.Secretions from the tracheostomy site (character and amount)Presence of drainage on tracheostomy dressing or ties.Appearance of incision (redness, swelling, purulent discharge, or odor)

What are some indicators for a tracheostomy?

Indications for Tracheostomy General indications for the placement of tracheostomy include acute respiratory failure with the expected need for prolonged mechanical ventilation, failure to wean from mechanical ventilation, upper airway obstruction, difficult airway, and copious secretions (Table 1).

How do you describe a tracheostomy secretion?

Secretions are a natural reaction to tracheostomy, not a sign of a problem. A trach tube bypasses the upper airway, which normally cleans and moistens the air. This causes the body to produce more secretions. When tracheostomy cuffs are kept inflated for a prolonged period, these secretions can pool in the airway.

What is a swallow test after a tracheostomy?

A few drops are put into the mouth and the patient is asked to swallow; after a few swallowing actions the coughing reflex is checked for with methylene blue coming out of the tracheostomy cannula (immediate inhalation). Bronchoaspiration is performed to check for any methylene blue in the trachea (aspiration).

What are the responsibilities of a nurse to the patient with a tracheostomy tube?

ProcedureClearly explain the procedure to the patient and their family/carer.Perform hand hygiene.Use a standard aseptic technique using non-touch technique.Position the patient. ... Perform hand hygiene and apply non-sterile gloves.Remove fenestrated dressing from around stoma.More items...

What are the complications of tracheostomy?

Complications and Risks of TracheostomyBleeding.Air trapped around the lungs (pneumothorax)Air trapped in the deeper layers of the chest(pneumomediastinum)Air trapped underneath the skin around the tracheostomy (subcutaneous emphysema)Damage to the swallowing tube (esophagus)More items...

Why is suctioning important in a tracheostomy?

Suctioning clears mucus from the tracheostomy tube and is essential for proper breathing. Also, secretions left in the tube could become contaminated and a chest infection could develop. Avoid suctioning too frequently as this could lead to more secretion buildup.

How is nutrition maintained for a patient with a tracheostomy?

Eat slowly and chew food well before you swallow. Drink plenty of fluids. Fluids help keep your mucus thin and prevent mucus buildup. At first, you may be advised to drink thicker fluids, such as soups and nonalcoholic blended drinks.

What is the normal tracheostomy cuff pressure?

Ideally, the cuff pressure should be between 20 and 30 cm H2O. Higher cuff pressure may compress tracheal capillaries, limit blood flow, and predispose the patient to tracheal necrosis.

How do you clear mucus from a tracheostomy tube?

After suctioning the trach tube: Pour a few ounces of hydrogen peroxide into a small clean container. Suction hydrogen peroxide through the catheter until it is free of mucus. Wipe the outside of the catheter with a cloth or gauze wet with peroxide.

When is suctioning indicated?

Suctioning is performed when the patient is unable to effectively move secretions from the respiratory tract. This may occur with excessive production of secretions or ineffective clearance, which leads to the accumulation of secretions in the upper and lower respiratory tract.

What was reinserted through a tracheostomy?

A bronchoscope was then reinserted through the tracheostomy and some secretions were removed and there was minimal blood suctioned as well.

What type of trach is used for Sequential Dilation?

Sequential dilation was then performed using the percutaneous tracheostomy kit and a #8 Shiley trach was inserted without difficulty.

What is tracheostomy care?

Tracheostomy care is provided on a routine basis to keep the tracheostomy tube’s flange, inner cannula, and surrounding area clean to reduce the amount of bacteria entering the artificial airway and lungs. See Figure 22.9 [1] for an image of a sterile tracheostomy care kit.

How often should you clean a tracheostomy tube?

Some inner cannulas are designed to be disposable, while others are reusable for a number of days. Follow agency policy for inner cannula replacement or cleaning, but as a rule of thumb, inner cannula cleaning should be performed every 12-24 hours at a minimum. Cleaning may be needed more frequently depending on the type of equipment, the amount and thickness of secretions, and the patient’s ability to cough up the secretions.

How to clean a stoma?

Clean the stoma with cotton applicators using one on the superior aspect and one on the inferior aspect. With your dominant, noncontaminated hand, moisten sterile gauze with sterile saline and wring out excess. Assess the stoma for infection and skin breakdown caused by flange pressure.

How to apply sterile tracheostomy split sponge dressing?

Apply the sterile tracheostomy split sponge dressing by only touching the outer edges.

How to pick up a cannula?

Pick up the inner cannula with your nondominant hand, holding it only by the end usually exposed to air.

What dressing is used for a tracheostomy?

tracheostomy split sponge dressing. , sterile basin, normal saline, and a disposable inner cannula or a small, sterile brush to clean the reusable inner cannula). Perform safety steps: Perform hand hygiene. Check the room for transmission-based precautions.

Why do you need to change the inner cannula?

Changing the inner cannula may encourage the patient to cough and bring mucus out of the tracheostomy. For this reason, the inner cannula should be replaced prior to changing the tracheostomy dressing to prevent secretions from soiling the new dressing. If the inner cannula is disposable, no cleaning is required. [2]

What is a tracheostomy?

Tracheostomy. A tracheostomy is an opening into the trachea through the neck just below the larynx through which an indwelling tube is placed and thus an artificial airway is created. It is used for clients needing long-term airway support.

What is the process of removing a tracheostomy tube?

Decannulation: The process whereby a tracheostomy tube is removed once patient no longer needs it.

Why does my cannula not work?

SUCTION: If coughing or removing the inner cannula do not work, it may be that secretions are lower down the patients airway. Use the suction machine to remove secretions.

What is the outer cannula used for in tracheostomy?

Tracheostomy tubes have an outer cannula that is inserted into the trachea and a flange that rests against the neck and allows the tube to be secured in place with tape or ties. Tracheostomy tubes also have an obturator which is used to insert the outer cannula which is then removed afterwards.

Why do you suction the entire length of a tracheostomy tube?

Suction the full length of the tracheostomy tube to remove secretions and ensure a patent airway.

How often should a tracheostomy be cleaned?

Initially a tracheostomy may need to be suctioned and cleaned as often as every 1 to 2 hours. After the initial inflammatory response subsides, tracheostomy care may only need to be done once or twice a day, depending on the client. Definition of Terms. Components of Tracheostomy Tube. Providing Tracheostomy Care.

Why is it important to care for the skin at the tracheostomy site?

Care for the skin at the tracheostomy site is important especially for the elders whose skin is more fragile and prone to breakdown.

How many incidents of tracheostomy are associated with patient harm?

A study by McGrath (2009) found that 75% of the 453 incidents with tracheostomy were associated with patient harm.

Where should oxygen be placed in a cuffed tracheostomy tube?

The patient with a cuffed tracheostomy tube will mostly breathe through the tracheostomy tube and therefore the oxygen should be placed at the site of the tracheostomy tube. If the patient is in distress, oxygen can be placed on both the tracheostomy site and the upper airway (mouth/nose).

What is simulation training for tracheostomy patients?

Simulation training for patients with tracheostomy can include tracheostomy care such as cleaning the inner cannula, stoma care, suctioning, cuff inflation/deflation, cuff management, changing a tracheostomy tube and speaking valves. Emergency situations can also be trained such as airway obstruction or accidental removal of the tracheostomy tube.

What does a nurse do when she walks down the hallway?

While walking down the hallway, you encounter a nurse who stepped into the hallway to call for help. The nurse states she was doing routine vitals check and diaper change when she noticed that the patient looks pale, anxious, and is working harder to breathe.”. Initial vital signs.

Is tracheostomy a high risk patient?

Tracheostomy simulation labs have been show to be effective tools for hands on learning without causing harm to a patient. Patients with tracheostomy can be classified as high risk patients, having a high potential for injury if they do not receive adequate care.

Can a tracheostomy tube be displaced?

Emergency situations can also be trained such as airway obstruction or accidental removal of the tracheostomy tube. There can be a displaced tube scenario where the tube is occluded with tape and placed under the chest flap of the manikin. The airway can be partially blocked for a difficult reinsertion.