Trach Care

Question 1

Nursing Care of Pt w/ Trach

Answer 1

• Stoma care
• Humification of airway
• Suctioning
• Ensure placement & patency
• Monitor cuff pressures
  > 14-20 mmHg
• Maintain extra trach & obturator at bedside
• Frequent oral care
• Aspiration precautions

Question 2

Stoma Care

Answer 2

• Assess pt
• Secure tracheostomy tubes in place
• Prevent accidental decannulation
• Teach pt & family how to perform trach care

Question 3

Humidification of Airway

Answer 3

• Tracheostomy tube bypasses nose & mouth, which is normally humidify, warm, & filter air
• Air must be humified
• Maintain proper temp
• Ensure adequate hydration

Question 4

Suctioning

Answer 4

1. Assess need for suctioning
   > unnecessary suctioning causes mucosal damage, bleeding, & bronchospasm
2. Wash hands, don protective eyewear, maintain standard precautions
3. Explain to pt tht sensations of SOB & coughing are expected
4. Check suction source
5. Set up sterile field
6. Preoxygenate (hyperventilate) pt w/ 100% oxygen for 3 ventilations prior to suction
7. Quickly into suction cath until resistance
   > do not apply suctioning during insertion
8. With cath 1-2m, & begin suction. Twirling motion during withdrawal
   > NOT longer than 10-15secs
9. Hyperoxygenate for 1-5mins or until baseline HR & oxygen sat are within normal limits

Question 5

Complications of Suctioning

Answer 5

• Hypoxia
• Tissue (mucosal) trauma
• Infection
• Vagal stimulation & bronchospasm
• Cardiac dysrhythmias (hypoxia)

Question 6

Causes of Complications

Answer 6

• Ineffective oxygenation before, during, after suctioning
• Use of cath tht is too large for artifical airway
• Prolonged suctioning time
• Excessive suction pressure
• Too frequent suctioning

Question 7

Concerns w/ Trachs

Answer 7

• Aspiration
  > inflated cuff can interfere w/ passage of food through esophagus
  > weakened muscle
• Elevate HOB for at least 30mins after eating to prevent aspiration furing swallow
• May ened to be placed on enteral feeding

Question 8

Psychosocial Support for Pt w/ Trach

Answer 8

• Communication
  > ensure involvement w/ speech therapy
  > offer communication tools
  > patience
• Support for pts & families
• Offer opportunities to express concerns
• Encourage pts w/ permanent trachs to become involved in self care