1. The client/caregiver can define a tracheostomy.
    1. It is the insertion of a tube into the trachea by making a surgical incision.
    2. The opening is called a “stoma.”
    3. It can be permanent or temporary.
  2. The client/caregiver can list indications for the use of a tracheostomy tube.
    1. Tumor occluding the airway
    2. Upper airway obstruction from a foreign body, edema, or mucus
    3. Radial neck resection surgery or laryngectomy
    4. Inability to maintain a patent airway
    5. To provide a method of mechanical ventilation
  3. The client/caregiver can describe a tracheostomy tube.
    1. The tracheostomy tube can be semiflexible plastic, rigid plastic, or metal.
    2. The tracheostomy tube consists of
      1. Outer cannula
      2. Inner cannula
      3. Obturator (used for initial placement and then removed)
    3. The tube may be cuffed or uncuffed.
    4. The tube is held in place by Velcro strips fastened around the neck. Usually sterile gauze pads (drain or pre-cut by manufacturer) are placed between the skin and edges of the tracheostomy cuff. Avoid cutting a gauze pad because fragments of gauze may enter the stoma.
  4. The client/caregiver can demonstrate cleaning the inner cannula.
    1. Wash hands. Put on clean gloves and remove soiled gauze dressing. Discard dressing inside of removed gloves.
    2. Wash hands and open tracheostomy cleaning kit without contamination.
    3. Put on sterile gloves.
    4. Add sterile normal saline in one side of the sterile kit basin and equal parts hydrogen peroxide and saline in the other side.
    5. If kit does not include sterile saline and peroxide, have assistants pour correct solutions.
    6. Unlock inner cannula and turn counter-clockwise. Remove and place in peroxide and saline solution to soak.
    7. Clean inside and outside the outer cannula with a brush or pipe cleaner.
    8. Rinse cleans the cannula in normal saline and removes excess liquid by tapping against the basin.
    9. Replace the inner cannula and turn clockwise until it clicks into place and dots on both cannula match.
    10. Cleanse around the stoma with Q-tips dipped into hydrogen peroxide.
    11. Then rinse with a normal saline soaked Q-tip.
    12. Replace drain (precut) gauze under the sides of the outer cannula.
    13. Check ties for fit and evaluate whether it needs to be changed due to soiling.
    14. After cleanup, place a pressure call bell, tap bell, or whatever method is used for the client to signal for assistance.
  5. The client/caregiver can demonstrate changing tracheostomy ties.
    1. Always have two people for this procedure so that one person can hold the tube firmly in place while the other person changes the ties.
    2. Use the Velcro strips provided in the tracheostomy care kit.
    3. Allow enough space for the little finger to fit between the strip and the client’s skin.
  6. The client/caregiver is aware of the need for skin care.
    1. Assess for signs and symptoms of infection (i.e., fever, redness, and irritation).
    2. Cleanse skin frequently, and place a dry gauze around the stoma.
  7. The client/caregiver can state the procedure to follow if the trach tube accidentally falls out.
    1. Remove the inner cannula from the dislodged tube.
    2. Insert the obturator into the outer cannula, and reinsert the tube.
    3. Remove the obturator and insert the inner cannula.
  8. The client/caregiver can list general precautions.
    1. Do not allow smoking in the same room.
    2. Avoid aerosol sprays and dust that may enter the trach.
    3. Provide adequate humidification.
    4. Keep a suction machine at the bedside at all times.
    5. Perform suctioning as needed, but avoid over-suctioning because it may increase secretions.
    6. Tape the obturator to the head of the bed, and keep an extra tracheostomy set and hemostat at the bedside.
    7. Prevent infection with good oral hygiene; avoid persons with respiratory infections. Use good hand-washing procedures.
    8. Avoid getting any water into the stoma.
    9. Use other communication techniques if speaking is impaired (call bell, sign language, pictures, etc.).
    10. Cover the stoma loosely if going out into very cold weather.
    11. Drink at least 3000 ml of water per day unless contraindicated.
    12. Avoid smoking.
    13. Wear a Medic Alert bracelet.
    14. Keep follow-up appointments with physician.

Resources

American Head and Neck Societywww.headandneckcancer.org/patienteducation/docs/tracheostomy.php
Speech therapist
Support groups
Medical supply company

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.Canobbio, M. M. (2006). Mosby’s handbook of patient teaching. St. Louis: Mosby Inc.Taylor, C., Lillis, C., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott, Williams & Wilkins.Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott

Credits

Client Teaching Guides for Home Health Care, 2nd ed.© 2008 Jones and Bartlett Publishers, Inc.www.jbpub.com

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