As with any surgery, there are some risks associated with tracheotomies. However, serious infections are rare.
Early Complications that may arise during the tracheostomy procedure or soon thereafter include:
Many of these early complications can be avoided or dealt with appropriately with our experienced surgeons in a hospital setting.
Over time, other complications may arise from the surgery.
Later Complications that may occur while the tracheostomy tube is in place include:
These complications can usually be prevented or quickly dealt with if the caregiver has proper knowledge of how to care for the tracheostomy site.
Delayed Complications that may result after longer-term presence of a tracheostomy include:
A clean tracheostomy site, good tracheostomy tube care and regular examination of the airway by an otolaryngologist should minimize the occurrence of any of these complications.
The risks associated with tracheostomies are higher in the following groups of patients:
Many nurses lack essential training to manage blocked or dislodged tracheostomy tubes. This article provides information on the care of patients with a tracheostomy Abstract The National Confidential Enquiry into Patient Outcome and Death in 2014 concluded that tracheostomy care fell below what is safe and reasonable to expect, and that staff needed training in this essential skill. This article, the first of a four-part series on all aspects of tracheostomy management, discusses the principles of tracheostomy care. Citation: Everitt EÂ (2016) Tracheostomy 1: caring for patients with a tracheostomy.Â Nursing Times; 112: 19, 16-20. Author:Â Erica Everitt is specialist tracheostomy practitioner at Norfolk and Norwich University Hospitals Foundation Trust. This article has been double-blind peer reviewed Scroll down to read the article orÂ download a print-friendly PDF here Click hereÂ to see other articles in this series
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Tracheostomy NCLEX Review and Nursing Care Plans
A tracheostomy is an opening that is made through the neck and into the trachea. The tracheostomy tube is inserted into the opening for breathing purposes.
Uses of a Tracheostomy
Tracheostomy is performed due to several reasons concerning the airway. The following situations may call for a tracheostomy:
Risk of a Tracheostomy
Generally, Tracheostomy is safe. However, in some cases, complications happen most of the time while the surgery is ongoing or right after the procedure is done. The risk increases when the procedure is performed in an emergency.
Early complications may include the following:
Long-term problems may occur when the tracheostomy tube is longer in place. These complications include:
For long-term use of tracheostomy, it is recommended to set a schedule of regular appointments for monitoring, especially for any complications. Notify the physician immediately if any of the following arises:
Before the Procedure
At the time that the doctor determines if the patient needs to have a tracheostomy and the patient decides to undergo the procedure, informed consent must be obtained. Also, the doctor needs to assess the neck’s range of motion. The team of doctors who will perform the procedure, including a surgeon, anesthesiologists, and others need to deliberate the entire sequence and if there’s an alternative to the operation. An organized and strict procedure in preparation and actual surgery is applied and maintained to avoid any incidence of procedural complications.
During the Procedure
During the surgery, the anesthesiologist is in charge of airway management, facilitates intravenous sedation, and performs bronchoscopy. An intubation roll, cricoid hook, and tracheostomy set are also at hand. The patient is placed in a lying position, the neck is extended unless contraindicated. Anesthesia will be provided as directed by the anesthesiologist.
A small cut is performed onto the tissue to push down the thyroid isthmus. Next, bronchoscopy is performed to identify the best side to introduce the needle. The needle is placed at the lower edge of the light reflex, directed to the tracheal lumen to avoid the posterior tracheal wall. The tracheostomy tube is placed in the tracheal lumen under direct visualization.
To confirm the placement, the bronchoscope is introduced to the tracheostomy tube and placement is confirmed by seeing the carina.
To secure the tube, 2 sutures of 2-0 nylon on both sides of the flange. To make it more secure, tracheostomy tape is added to hold the tube in place.
Tracheostomy Nursing Care
The tracheostomy tube, the stoma and the skin surrounding it need special care to prevent complications. Before being discharged from the hospital, the nurse will demonstrate to the patient the proper way of taking care of the tracheostomy tube. Routine tracheostomy care should be done at least once a day or as necessary. The following are the step-by-step procedures in tracheostomy care.
2. Suctioning a Tracheostomy Tube
Tracheal suctioning is done to remove mucus stuck in the tracheostomy tube to prevent blockage in the tracheostomy tube. It also removes secretion in the airway, to maintain clear and patent air passage. If done properly and cautiously, suctioning is a life-saving procedure by decreasing the risk of infection, build-up of secretions, and decreasing the level of oxygen. Indications of tracheal suctioning include the presence of secretions that can be visually or audible by hearing noisy respiration, signs of airway obstruction such as expanded breath sounds during expiration, an increase in respiratory effort, below-normal oxygen saturation, restlessness, and chronic cough.
Below is the step-by-step procedure when suctioning a tracheostomy tube:
3. Emergency Care of a Tracheostomy Tube
Nursing Diagnosis for Tracheostomy
Tracheostomy Nursing Care Plan 1
Ineffective Airway Clearance related to thick and copious respiratory secretions secondary to tracheostomy as evidenced by the patient being postoperative from tracheostomy placement, ineffective cough, shortness of breath, and presence of crackles and rhonchi on auscultation.
Desired Outcome: The patient will demonstrate clear airways and normal breath sounds by discharge.
Tracheostomy Nursing Care Plan 2
Risk for Impaired Gas Exchange
Diagnosis: Risk for Impaired Gas Exchange related to thickened tracheal secretions secondary to tracheostomy.
Desired Outcomes: The patient will sustain a sufficient gas exchange, arterial blood gas result is within the normal range and will show no signs of desaturation, oxygen saturation is maintained at 90% and greater, relaxed breathing, and alert level of consciousness.
Tracheostomy Nursing Care Plan 3
Risk for Infection
Diagnosis: Risk for Infection related to surgical incision of tracheostomy secondary to tracheostomy.
Desired Outcomes: The patient will be negative from any infection, as shown by normal body temperature, normal sputum culture, normal results in white blood cell count, clear breath sounds, and clean stoma without any presence of drainage.
Tracheostomy Nursing Care Plan 4
Risk for Aspiration
Diagnosis: Risk for Aspiration related to the presence of tracheostomy tube
Desired Outcomes: The patient will not have an instance of aspiration and can eat and drink without coughing, choking, or presence of skin discoloration.
Tracheostomy Nursing Care Plan 5
Risk for Injury
Diagnosis: Risk for Injury related to tracheostomy care
Desired Outcomes: The patient will demonstrate the absence of restlessness, difficulty breathing and the tracheostomy tube will remain patent and in place.
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