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Procedure On Tracheostomy
Procedure On Tracheostomy
Submitted To:
Submitted by :
Mohamad Dildar
CIMSR-DDN
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Tracheostomy
Introduction: A tracheostomy is a surgical opening into the trachea below the larynx through
which an indwelling tube is placed to overcome upper airway obstruction, facilitate mechanical
ventilator support and/or the removal of tracheo-bronchial secretions.
Definition: The surgical formation of an opening into the trachea through the neck specially
to allow the passage of air.
It begins as a continuation of the larynx at the lower border of the cricoid cartilage at the
level of the 6th cervical vertebra.
Trachea ends at the carina by dividing into right and left principal (main) bronchi at the
level of the sternal angle.
In adults the trachea is about 4½ in. (11.25 cm) long and 1 in. (2.5 cm) in diameter.
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Relations of the Trachea in the Neck :
Anteriorly: Skin, fascia, isthmus of the thyroid gland (in front of the second, third,
and fourth rings), inferior thyroid vein, jugular arch, thyroidea ima artery (if
present), and the left brachiocephalic vein in children, overlapped by the
sternothyroid and sternohyoid muscles.
Posteriorly: Right and left recurrent laryngeal nerves and the esophagus.
Laterally: Lobes of the thyroid gland and the carotid sheath and its contents
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Anteriorly: The sternum, the thymus, the left brachiocephalic vein, the origins of
the brachiocephalic and left common carotid arteries, and the arch of the aorta.
Right side: The azygos vein, the right vagus nerve, and the pleura.
Left side: The arch of the aorta, the left common carotid and left subclavian
arteries, the left vagus and left phrenic nerves, and the pleura
The upper two thirds are supplied by the inferior thyroid arteries and the lower
third is supplied by the bronchial arteries.
The lymph drains into the pretracheal and paratracheal lymph nodes and the deep
cervical nodes.
The sensory nerve supply is from the vagi and the recurrent laryngeal nerves.
Sympathetic nerves supply the trachealis muscle
Indication:
3. To permit long-term ventilator support- Should be done early in case where long –term
support is anticipated:
Coma
Neuromuscular disorders
Chronic obstructive pulmonary disease (COPD)
Multiple injuries
Impaired mental status
4. Obstructions in the upper airway caused by oedema, inflammation, infection of the glottis or
by carcinoma of the larynx are few of the important indications for tracheostomy.
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5. Inability to wean from ventilation after intubation.
Contraindication:
Article:
Tracheostomy set containing:
1. Toothed dissecting forceps-1
2. Curved mosquito forceps-2
3. Straight mosquito forceps-2
4. Artery forceps-2
5. Allis forceps-2
6. Needle holder
7. Double hook retractors-2
8. Blunt hook
9. Cricoids hook
10. Sharp scissors
11. Tracheal dilator
12. Gallipots-2
13. Cutting edge suture needle with cotton thread
14. Vaseline gauze
A clean tray containing:
1. Suction catheter with connection (sterile)
2. Hand towel
3. Kidney basin
4. Scalpel blade (sterile)
5. Gloves (sterile)
6. Mask
7. Apron
8. Anticeptic solution
9. Local anesthetic (xylocaine 2%)
10. Syringes (sterile)
11. Needles (sterile)
12. Sandbag
13. Spot light
14. Tracheostomy tube
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Types of tracheostomy tube:-
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Procedure:
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Nursing action Rationale
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Complications:
The four most important immediate surgical complications are:
1. Bleeding around the Tracheostomy tube.
2. Subcutaneous emphysema, mediastinal emphysema and pneumothorax.
3. Aspiration of blood in the airway.
4. Cardiac arrest secondary to hypoxia, acidosis or sudden electrolyte shifts.
Postprocedural care:
1. Connect to ventilator (if needed).
2. Place patient in semi-Fowler’s position.
3. Check vital signs.
4. Administer analgesics and sedative as per order.
5. Watch for complications like bleeding, respiratory failure and blockage of
tracheostomy tube with secretions.
6. If metal tube is inserted, leave the stillate in a sterile tray at the bedside.
7. Keep suction apparatus and suction tube ready at bedside.
Assessment
Respiratory status (ease of breathing, rate, rhythm, depth, lung sounds, and oxygen
saturation level)
Pulse rate
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Secretions from the tracheostomy site (character and amount)
Presence of drainage on tracheostomy dressing or ties
Appearance of incision (redness, swelling, purulent discharge, or odor)
Equipment
Procedure
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Put on a pair of sterile gloves).
Suction the full length of the tracheostomy tube to remove secretions and
ensure a patent airway.
Rinse the suction catheter and wrap the catheter around your hand, and peel the
glove off so that it turns inside out over the catheter.
Unlock the inner cannula with the gloved hand. Remove it by gently pulling it
out toward you in line with its curvature. Place it in the soaking
solution. Rationale: This moistens and loosens secretions.
Remove the soiled tracheostomy dressing. Place the soiled dressing in your
gloved hand and peel the glove off so that it turns inside out over the dressing.
Discard the glove and the dressing.
Put on sterile gloves. Keep your dominant hand sterile during the procedure.
6. Clean the inner cannula.
Insert the inner cannula by grasping the outer flange and inserting the cannula
in the direction of its curvature.
Lock the cannula in place by turning the lock (if present) into position to
secure the flange of the inner cannula to the outer cannula.
8. Clean the incision site and tube flange.
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area using gauze squares moistened with sterile normal
saline. Rationale: Hydrogen peroxide can be irritating to the skin and inhibit
healing if not thoroughly removed.
Clean the flange of the tube in the same manner.
Thoroughly dry the client’s skin and tube flanges with dry gauze squares.
9. Apply a sterile dressing.
Place a folded 4-in. x. 4-in. gauze square under the tie knot, and apply tape over the
knot. Rationale: This reduces skin irritation from the knot and prevents confusing the
knot with the client’s gown ties.
Frequently check the tightness of the tracheostomy ties and position of the tracheostomy
tube. Rationale: Swelling of the neck may cause the ties to become too tight, interfering
with coughing and circulation. Ties can loosen in restless clients, allowing the
tracheostomy tube to extrude from the stoma.
Record suctioning, tracheostomy care, and the dressing change, noting your assessments.
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NURSING RESPONSIBILITY
1. Tracheostomy dressing should be done every 8 hours or whenever dressing is soiled.
2. If disposable inner cannula is present, then replace the one that is inside with a new
one.
3. If only single lumen is present, clean the neck plate and tracheostomy site.
4. Emphasize the importance of handwashing before performing tracheostomy care.
5. Proper way on how to remove, change and replace the inner cannula.
6. Check and clean the tracheostomy stoma.
7. Assess for symptoms of infection.
Conclusion
Tracheostomy is a safe procedure and gives a good alternative to delayed endotracheal
extubation in post-operative patients expected to have respiratory failure in places where
post-operative anaesthetic care is lacking.
Summary
A tracheostomy is a surgical procedure that involves making a cut in the trachea
(windpipe) and inserting a tube into the opening. A tracheostomy may be temporary or
permanent, depending on the reason for its use. Certain groups, including babies, smokers
and the elderly, are more vulnerable to complications.
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Bibliography
Goel Ashish, joshi Rajnish, jain AP; ICU manual, 3rd Edition,2013, Paras Medical
Publiser; 62-66.
Clinical nursing procedure: the art of nursing practice.2nd edition,2011, jaypee
publishers;page- 422-424
Jacob annmma;Rekha R;clinical nursing procedures.
Anatomy images; http://www.annalscts.com/article/view/16463/16669;
https://healthiack.com/encyclopedia/trachea-diagram/attachment/trachea-diagram-503.
Procedure Images; https://www.practo.com/health-wiki/tracheostomy-symptoms-
complications-and-treatment/264/article;
https://www.doereport.com/generateexhibit.php?ID=10089.
Part of Tracheostomy tube images;
https://www.pinterest.com/pin/199847302193183933/;
https://www.slideshare.net/surgerymgmcri/tracheostomy-class.
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