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Nursing Knowledge
A tracheostomy is a hole (stoma) through the neck into the trachea (windpipe). A tube is inserted into this hole to allow air to enter the lungs bypassing the upper airways. This can be necessary when the client’s airway is blocked or if long-term ventilator support is required.
Tracheotomy is the actual surgical procedure of cutting into the trachea, typically performed under general anesthesia. Tracheostomy refers to the resulting stoma or opening that remains after a tracheotomy.
While a tracheostomy is the result of a planned surgical procedure and intended for long-term airway management, a cricothyrotomy is an emergency procedure performed when there's an acute obstruction of the upper airway. An incision is made in the cricothyroid membrane (between the larynx and the trachea) to establish airflow.
It's possible to speak with a tracheostomy, but it might be challenging. Speaking requires air to flow over vocal cords, which can be interrupted by a tracheostomy. Affected persons may need speech therapy or a speaking valve, which allows air to be redirected over the vocal cords during exhalation.
A tracheostomy can be either temporary or permanent. For clients whose condition improves (e.g. after an injury), it can be temporary, while for others (e.g. with chronic respiratory issues), a tracheostomy can be a permanent solution.
The basic supplies needed for performing trach care are:
To be prepared for emergency situations when performing trach care, you need the following supplies:
If you notice signs of inflammation or infection around the stoma site, you should clean around the stoma site with moistened saline gauze or sterile tipped cotton applicators. Discard after each wipe. Do not get any gauze fibers in the stoma site! Dry skin around the trach site thoroughly with dry sterile 4x4 gauze.
To properly clean the inner cannula of a tracheostomy tube, first stabilize the trach faceplate and carefully unlock the inner cannula and remove it. Cleanse it with saline and a soft brush and dry thoroughly or replace it with a new disposable cannula per policy. Then, insert a clean or new inner cannula and lock it into place.
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