A tracheostomy is a surgical procedure that involves making an incision (stoma) into the trachea through the front of the neck. A tube is then inserted into the incision, creating an air passage that allows the patient to breathe directly through their trachea while avoiding their upper airway. This may be a temporary or permanent intervention (Healthdirect 2018; Mayo Clinic 2019). You may be called to assist a patient or caregiver with a tracheostomy in the pre-hospital arena; it is vital to ensure you care for a tracheostomy carefully and thoroughly, as an adverse event such as respiratory distress may develop if the tracheostomy is not managed properly.
Patient care and safety may be compromised if correct tracheostomy procedures are not followed. Suctioning performed improperly can cause complications such as hypoxia, atelectasis, bradycardia, trauma and infection. Airway impairment can be life threatening.
When dealing with tracheostomy tubes, ensure that Standard & Transmission-based Precautions are employed. Perform hand hygiene and put on personal protective equipment (PPE). Maintain the sterility of the catheter.
There are a variety of tracheostomy tubes available with some or all of the following features, depending on what the patient requires:
(NSW DoH 2015; Dawson 2014; Craig Hospital 2014; CCAM 2016)
All children in Western Australia with a tracheostomy will have an Airway Profile. The Airway Profile will outline:
Tracheostomy airway impairment may occur due to:
Emphasis is on early recognition of any change in the patient’s respiratory status and tube patency to avoid an emergency event. Late signs of impending respiratory collapse include cyanosis, bradycardia and apnoea – do not wait for these to develop before intervening.
Suction should maximise removal of secretions while minimising tissue damage and hypoxia in order to maintain a patent airway and allow effective ventilation.
The routine suction depth will be recorded on the patient’s Airway Profile. Deep suctioning is not to be performed.
|Tracheostomy tube size (mm)||3.0||3.5||4.0||4.5||5.0||6.0||7.0|
|Suction catheter size (Fr)||6.0||7.0||8.0||8.0||10.0||12.0||12.0|
|Deane Coxall, AP14227|