Tracheostomy Slide Presentation-zaychung.pro.ksa

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 As soon as the catheter withdrawn , re-connect to the ventilator or oxygen supply source.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. 2. 3. 4. 6. 7. 8. 9.

Explain to patient the procedure Privacy (Screen the area / Bed) Wash hand Perform the procedure under aseptic technique Remove the soiled dressing Clean trache stoma area with saline Replaced with tracheostomy dressing/keyhole 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 cancelled cheque… Tomorrow is a Promissory Note Today is Ready Cash…Use It

Thank You