Definition of "tracheostomy."
It is an incision made into the trachea to create an airway.
It can be permanent or temporary.
Description of the tracheostomy tube.
It can be metal or plastic.
Metal tube has an inner cannula.
Plastic tube may or may not have an inner cannula.
The tube may be cuffed or uncuffed.
The cuff should be deflated or inflated according to physician's orders.
The cuff should be inflated when eating and for one-half hour after eating to prevent food from going into trachea.
Never overinflate the cuff due to possible pressure necrosis of trachea.
Suction mouth and nose before deflating the cuff.
Perform tracheostomy care.
Wash hands and apply sterile gloves.
Cleanse around stoma with cotton swabs dipped into hydrogen peroxide.
Then rinse with normal saline-soaked cotton swab.
Dry with gauze.
Remove inner cannula; place in H2O2 and clean with a brush.
Rinse inner cannula with normal saline.
Shake off excess fluid, but do not dry.
Suction outer cannula; then reinsert inner cannula and lock in place.
How to change tracheostomy ties.
Always have two people for this procedure, one to hold the tube firmly in place while the other changes the ties.
Use 3/4-inch twill tape, and tie with a square knot.
Avoid tying knot over the carotid artery or spinal cord.
Tie firmly, but loose enough for two fingers to fit under tape.
Assess for signs and symptoms of infection.
Cleanse skin frequently, and place a dry gauze around stoma.
Apply ointment for protection if ordered.
General precautions caring for a tracheostomy.
Do not allow smoking in same room.
Avoid aerosol sprays and dust, which may enter trachea.
Provide adequate humidity.
Keep a suction machine at bedside at all times.
Perform suctioning as needed, but avoid oversuctioning because it may increase secretions.
Tape obturator to head of bed, and keep an extra tracheostomy set and hemostat at the bedside.
Use hemostat to keep tracheostomy open in case of accidental expulsion of tube.
Avoid getting water in stoma.
Use other communication techniques if speaking is impaired (bell, sign language, pictures, etc.).