University of Babylon

Faculty Of Nursing

Tracheostomy Care

:PREPARED BY
Master Student
Haider mohammed
ANATOMY
Tracheostomy
It is a surgical opening in the anterior wall of the
trachea just below the larynx. Or is an operative
procedure that creates a surgical airway in the
cervical trachea.A tracheostomy may be performed
.as a permanent and emergency procedure
: - INDICATIONS
.To provide and maintain patent airway- 1
To enable the removal of tracheo-bronchial- 2
.secretions
.To permit long term positive pressur ventilation- 3
.To improve patient comfort- 4
To decrease the work of breathing and increase - 5
volume of air entering the lungs
TYPESOFTRACHEOSTOMY
TUBES
Plastic or metal 
Cuffed 
Fenestrated 
TYPESOFTRACHEOSTOMY
TUBE

PLASTIC 

METAL 
TYPESOFTRACHEOSTOMY
TUBES

CUFFED 

FENESTRATED
Tracheostomy Speaking Valve
Tracheostomy Speaking Valve is designed to allow 
tracheostomy patients to vocalize without the need for
finger occlusion. The valve provides low resistant one-
way airflow using a thin silicone diaphragm that opens
on inspiration and closes on expiration. An exclusive
feature of this valve is a "cough-release" mechanism,
eliminating valve or tube dislodgment as a result of
.coughing or excessive airwaypressure
Indications For use as a one-way speaking valve
on a tracheostomy tube

Features
Easy to use and maintain- 1
Low resistance to inspired airflow- 2
Exclusive cough-release feature-3
speaking valve
.Contraindications
Suspected CSF leak (BOS fracture) or raised in ter - 1
.cranial pressure
.Tracheo/oesophageal fistula- 2
.Cancer in upper GI or respiratory tract - 3
.Oesophageal or high GI surgery- 4
ANATOMICAL POSITIONING OF
TRACHEOSTOMYTUBE
COMPLICATIONS
Immediate
Hemorrhage- 1
Hypoxia- 2
Trauma to recurrent laryngeal nerve- 3
Damage to esophagus- 4
Pneumothorax- 5
Infection- 6
Subcutaneous emphysema- 7
COMPLICATIONS
Early
Tube obstruction or displacement- 1
Pooling of secretions leading to aspiration- 2
Bleeding from tracheostomy site- 3
Infection- 4
COMPLICATIONS
Late
Airway obstruction with aspiration- 1
(Damage to larynx (Stenosis- 2
Tracheal stenosis- 3
Tracheomalacia- 4
Aspiration and pneumonia- 5
Fistula formation .eg. Tracheo- cutaneous o r - 6
tracheo-oesopheal
CAREOFTHEPATIENTWITH
TRACHEOSTOMY
Stoma care
.care towards hygiene and asepsis is necessary-1
Remember the skin surrounding the stoma i s - 2
.also prone to irritation
as per hospital policy and barrier cream- 3
applied to the local skin cotton wool should
.be avoided
CAREOFTHEPATIENT WITH
TRACHEOSTOMY
Tube care
.Tubes need to be cleaned- 1
The area should be cleaned with normal saline {In- 2
double cannula the inner cannula will need to be
.removed and to be cleaned
For cuffed tracheostomy tubes the pressure should- 3
{.be measured in every shift{ as per hospital policy
CAREOFTHEPATIENT WITH
TRACHEOSTOMY
Suctioning
Suctioning should be done PRN ,after chest PT a n d - 1
Nebulization
Use the lowest pressure needed ,usually less t h a n - 2
.120 mmHg and definitely not beyond 200mmHg
Suctioning should be performed less t h a n - 3
.10seconds
Hazards Of Suctioning
.Patient anxiety- 1
.Changes in ICP- 2
. Trauma- 3
.Infection- 4
.Pneumothorax- 5
.Hypoxia- 6
.Cardiac hazard- 7
CAREOFTHEPATIENT WITH
TRACHEOSTOMY
Humidification
The normal humidification and air filtration system- 1
is bypassed if the tracheostomy is in situate
Keep patients well hydrated- otherwise secretion- 2
.will become thicker and will lead to infection
Nursing Diagnosis
Risk of ineffective air way clearance - 1 
related to increase secretion secondary to
.tracheostomy
Risk for infection related to excessive- 2 
.polling of secretion
Impaired verbal communication related- 3 
to inability to produce speech secondary to
. tracheostomy
Nursing Management
The patient and all hospital staff will- 1 
demonstrate and apply hand washing technique
.through hospitalization
the nurse educate the patient and his family- 2 
.about transmission of infection after discharge
assess and maintain for adequate humidity of- 3 
.inspired air every two hours
keep stoma free from any debris or mucous- 4 
build up as needed
.check body vital sings- 5 
.keep patient with comfortable position- 6 
. give analgesic medication as or der - 7 
THINGS TOREMEMBER

DON’T PANIC 
STERILE TECHNIQUE 
SAFTEY FIRST 
CRITICAL THINKING 
NUTRITION 
COMMUNICATION 