How to Care for a Patient with a Tracheostomy
22 May 2023
Caring for someone with a tracheostomy is an intricate practice that requires special clinical training to undertake safely and effectively. But what needs to be taken into consideration when caring for a person with a tracheostomy and carrying out the procedures involved in this type of care? Read on to find out.
What is a Tracheostomy?
A tracheostomy is a surgical procedure where an opening is made in the trachea and an artificial airway called a tracheostomy tube is positioned so that the patient can breathe more easily.
Tracheostomies help protect the airway from being blocked by potential obstructions, including secretions or swelling in the trachea and also facilitate long term ventilation. There are a number of other factors that need to be taken into consideration when caring for a patient with a tracheostomy, including the role of the upper airway being bypassed by the procedure and how to clean equipment and site properly.
A tracheostomy tube is typically made up of three main parts:
The outer cannula: This keeps the tracheostomy from closing and always remains in place. It should only ever be removed by a medical professional.
The inner cannula: This slides in and out of the outer cannula, allowing for easier cleaning of the tracheostomy kit and preventing secretion build ups. These may not be present in tracheostomies for children.
Flange: This connects to the outer cannula and is where tracheostomy ties are secured. These wrap around the client’s neck, ensuring that it does not move out of place. Ties are checked regularly to ensure they are not too tight or too loose.
Tracheostomies may be un-cuffed or cuffed with a small balloon to seal the airway. They may also have fenestrations to allow air to move across the vocal cords.
What Equipment is Required for Tracheostomy Care?
Some key equipment includes:
- At least one suction machine
- Suction catheters
- Replacement inner cannulas (if using the replaceable kind)
- Spare ties
- Spare dressings
- Method of humidification
How to Care for A Patient with a Tracheostomy
Monitoring a patient with a tracheostomy is an extremely important and often intricate role to undertake. Nurses and specialist trained carers are taught how to care for someone with a tracheostomy during their training. There are a number of processes that must be taken into consideration when carrying out proper tracheostomy care.
These elements of tracheostomy care include:
Suctioning is a procedure that should be performed as and when it is needed. It involves the insertion of a catheter through the inner cannula to clear secretions from the airway, helping the client to breathe more easily.
Suction catheters are single use and are disposed of after use. Suction tubing can be reused in line with local policy but must always be cleaned after each suctioning takes place. Safety checks should be done on suctioning machines and equipment ensure they are in good working order.
Suctioning is a care technique that requires proper clinical training to execute. Our team of nurse-led carers undergo thorough training to learn how to facilitate these techniques.
Replacing/Cleaning the Inner Cannula
The inner cannula typically needs to be replaced twice per day in order to prevent secretion build up. The tube must be removed and cleansed with sterilised water (or replaced if using disposable cannulas). Some tracheostomy tubes require a temporary inner tube to be put in place while cleaning takes place.
The inner cannula should not be removed for more than a few minutes, otherwise mucus can build up, causing potential obstructions in the airway.
Cleaning the Skin Around the Stoma
The opening for the tracheostomy must also be cleaned daily to ensure that the site does not become irritated or infected. This is carried out using aseptic technique and sterile equipment to help reduce the risk of infection and make sure that the client is not in any discomfort.
When carrying out this step, the nurse/carer should always assess the client’s skin for abnormalities.
Moisturise the Air
As the upper airway is bypassed, so too are its roles in the typical breathing process. This includes warming, filtering and humidifying air, which in turn needs to be replicated.
The use of a Humidity Moisture Exchange (HME) filter over the end of the tracheostomy opening, regular Nebulisers or a warm water humidifier helps loosen any secretions that may have built up. The right amount of fluid intake also helps prevent this from occurring.
Note: It is also important to remember oral care for tracheostomy clients. As the upper airway is inactive, complications can occur in the client’s mouth if not appropriately cared for. Regular teeth brushing (which the patient can carry out themselves where appropriate) and antiseptic mouth washing should become part of the daily routine.
Our core teams of specialist carers are fully trained when it comes to caring for a patient with a tracheostomy. We train all of our carers in-house to ensure that their knowledge and skills are not only thorough but also matched to the individual care plan for each of our in-home complex care clients.
HFH Healthcare’s transparent and progressive governance framework warps around each commissioned package of care to ensure safety and quality of our service. This includes all aspects of our training from classroom-based theory, practical simulation, and clinical competency assessment to the ongoing supervision of our care teams in the community ensuring the application of current principles of best practice.
It is what allows us to help our clients and their families live their lives to the fullest that they can.
If you would like to learn more about the in-home complex care that we provide, or about the complex care jobs that we have available, please contact us on 0208 605 9714 or 0208 605 9712 respectively.