Tracheostomy
Tracheostomy
A tracheostomy, according to Medscape, is “an artificial opening made by a surgical incision into the trachea”. A physician may order a tracheostomy for several different reasons. The most common need for this procedure is to provide a patent airway. It is also used in conjunction with respiratory therapists to deliver supplemental oxygen to patients who are unable to adequately take in oxygen independently.
Primary nursing responsibilities are to maintain a patent airway, keep the inner cannula clean, prevent skin breakdown in the surrounding area, and provide a comfortable means of communication for the patient. In order to maintain a patent airway, it is always important to have a sterile packaged hemostat, as well as an extra tracheostomy set available at the bedside in case of dislodging of the outer cannula. Patients must also be regularly assessed for excess secretions and suction as often as needed. Frequent observation and auscultation of the lungs are essential to adequate assessments. Caregivers need to turn and reposition patients every 2 hours to achieve maximum ventilation and lung expansion. Changing the tapes or ties of the tracheostomy when soiled is important to decrease the chances of skin impairment. All respiratory therapy equipment must be changed every 8 hours and all condensed water on equipment need to be removed. Those who have tracheostomies will also need frequent mouth care as well as a preferred means of communication between the patient and caregiver such as a whiteboard and marker or electronic communicator that can speak typed in words. According to Nursing Times Journal, “The majority of patients with tracheostomies will be unable to speak, as the tube/stoma is positioned below the level of the vocal cords.” Thus, customize communization according to each patient. It is also imperative to remember that patients who have endotracheal tubes are allowed nothing by mouth. These patients will need
A tracheostomy, according to Medscape, is “an artificial opening made by a surgical incision into the trachea”. A physician may order a tracheostomy for several different reasons. The most common need for this procedure is to provide a patent airway. It is also used in conjunction with respiratory therapists to deliver supplemental oxygen to patients who are unable to adequately take in oxygen independently.
Primary nursing responsibilities are to maintain a patent airway, keep the inner cannula clean, prevent skin breakdown in the surrounding area, and provide a comfortable means of communication for the patient. In order to maintain a patent airway, it is always important to have a sterile packaged hemostat, as well as an extra tracheostomy set available at the bedside in case of dislodging of the outer cannula. Patients must also be regularly assessed for excess secretions and suction as often as needed. Frequent observation and auscultation of the lungs are essential to adequate assessments. Caregivers need to turn and reposition patients every 2 hours to achieve maximum ventilation and lung expansion. Changing the tapes or ties of the tracheostomy when soiled is important to decrease the chances of skin impairment. All respiratory therapy equipment must be changed every 8 hours and all condensed water on equipment need to be removed. Those who have tracheostomies will also need frequent mouth care as well as a preferred means of communication between the patient and caregiver such as a whiteboard and marker or electronic communicator that can speak typed in words. According to Nursing Times Journal, “The majority of patients with tracheostomies will be unable to speak, as the tube/stoma is positioned below the level of the vocal cords.” Thus, customize communization according to each patient. It is also imperative to remember that patients who have endotracheal tubes are allowed nothing by mouth. These patients will need
Cited: Tracheostomy care: An evidence-based guide to suctioning and dressing changes, Issue Date: July 2011 Vol. 6 No. 7 Author: Betty Nance-Floyd, MSN/Ed, RN, CNE http://www.americannursetoday.com/article.aspx?id=8022&fid=7986 The basic principles of nursing care and monitoring for patients with tracheostomies, Author: Dan Higgins,RGN, ENB 100, ENB 998, is senior charge nurse, critical care, University Hospitals Birmingham NHS Foundation Trust. http://www.nursingtimes.net/nursing-practice/clinical-zones/respiratory/basic-nursing-principles-of-caring-for-patients-with-a-tracheostomy/1973985.article Tracheostomy Tubes : Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine, Muhammad Kamaal Khan, MBBS, MRCSEd, DOHNS Specialty Registrar, Department of Otolaryngology and Head and Neck Surgery, Freeman Hospital, UK. http://emedicine.medscape.com/article/2044774-overview