Tracheostomy

A tracheostomy is a type of artificial airway consisting of a small, plastic tube that’s inserted through a surgically created opening, or stoma, in the anterior neck, known as a tracheotomy.

Typically, a tracheostomy is placed when a patient can’t keep their own airway open. It can be placed urgently when intubation by other means isn’t possible, or as a planned procedure, if the patient requires long-term airway assistance.

Now, patients with a tracheostomy typically have a short tube that protrudes from the anterior of their neck, which is usually stabilized with a flange and ties that encircle the neck. Many tracheostomy tubes have an outer cannula, which keeps the airway patent, and an inner cannula, which can be disposable or non-disposable and is removed for cleaning.

The tube may or may not be connected to a mechanical ventilator or another source of oxygen; and depending on the type of tracheostomy tube your patient has, they may or may not be able to talk.

Okay, so tracheostomy tubes come in various sizes and configurations. First, tubes can be cuffed, meaning there is a balloon that can be inflated to provide a leak-proof connection; or uncuffed, where there is no balloon.

Cuffed tubes are usually used short-term because they occlude the upper trachea and pharynx, and the pressure exerted can compress tracheal capillaries, limit blood flow, and predispose the patient to tracheal necrosis. On the other hand, uncuffed tubes are used for patients with long-term tracheostomies to decrease the risk to surrounding tissues.

It’s also important to note that tracheostomy tubes can be fenestrated or non-fenestrated. A fenestrated tube has a hole on its dorsal surface, which helps promote spontaneous breathing.

When patients have a cuffed, fenestrated tracheostomy tube, the cuff can be deflated and inner cannula removed. This allows air to pass from their lungs through the opening in the tube, enabling them to breathe spontaneously and speak.

Now, some patients may have a Passey-Muir valve, or PMV. The Passey-Muir valve is a one-way valve placed on the end of their tracheostomy, that allows them to speak by redirecting exhaled air through the vocal cords, rather than back through the tube. It’s important to remember that if a patient has a Passey-Muir valve in place, the cuff should be fully deflated, or they won’t be able to fully exhale.

Alright, now the nursing care you’ll provide for your patient with a tracheostomy involves promoting oxygenation and providing tracheostomy care.

To promote oxygenation, make sure your patient is receiving humidified air. Humidification not only warms and moisturizes secretions, but it helps thin secretions and decreases the formation of mucus plugs.

If your patient’s tracheostomy tube requires suctioning, be sure to always use sterile technique. During suctioning, observe the amount, color, and clarity of secretions, as well as how well they tolerate suctioning. If your patient has a newly placed tracheostomy tube, you should avoid suctioning in the first few hours after the procedure, as it can be painful and cause bleeding.