1. Humidification should be used during the immediate postoperative period and as necessary thereafter.
2. Humidification should be used if a patient requires mechanical ventilation.
3. Humidification should be used for patients with a history of thick secretions.
4. In a clinical setting, after the initial tube change, replacement of a tracheostomy tube should be supervised by experienced medical or nursing staff.
5. During hospitalisation and at home, the inner cannula should be cleaned regularly.
6. While at home, the tracheostomy tube should normally be replaced using a clean technique.
7. The stoma and tracheostomy tube should be suctioned when there is evidence of visual or audible secretions in the airway.
8. The stoma and tracheostomy tube should be suctioned if airway obstruction is suspected.
9. The stoma and tracheostomy tube should be suctioned before and after the tracheostomy tube is changed.
10. If there is a blockage in the tracheostomy tube, the tube should be replaced.
11. If the tracheostomy tube is malfunctioning, the tube should be replaced.
12. Tracheostomy tube cuff pressure should be checked routinely and adjusted as necessary.
13. A patient should not use a swallowing or speaking valve while the tracheostomy tube cuff is inflated.
14. Prior to cuff deflation, the tracheostomy tube and stoma should always be suctioned.
15. In the absence of aspiration, tracheostomy tube cuffs should be deflated when a patient no longer requires mechanical ventilation.
16. Utilisation of a defined tracheostomy care protocol for patient and caregiver education prior to discharge will improve patient outcomes and decrease complications related to their tracheostomy tube.
14.14 Home Management of the Patient with Tracheotomy
Patients discharged at home with tracheostomy are patients with long-term or irreversible conditions. In patient not requiring mechanical ventilation, this condition is achieved with an uncuffed long term tracheostomy cannula, that may be provided with a inner cannula (with or without speaking valve) that can easily removed and cleaned from secretion.
It is essential to organise home assistance, according to the resources made available by the health system or health insurance, as tracheotomised patients will need daily care for their tracheostomy.
Patients can be divided in:
Autonomous patients that can care for themselves or that have a supportive family environment that can provide help and care. This category of patients will in any case need frequent nursing or medical evaluation.
Patients that need daily community support by nurse with expertise in tracheostomy, but that can live in their home.
Patients that should be placed in a nursing home.
Before discharge, education on stoma and cannula care should be provided for patient and caregivers. Training on emergencies and simple algorithms to alert ambulance service should be prevue. Provision of supplies and emergency equipment should be available [16].
In patients with long-term use of tracheostomy, psychological surveillance should be provided, as tracheostomy tube can be associated with lower self-esteem and self-image.
All patients with tracheostomy should be scheduled for follow-up ambulatory care before discharge, to detect late complications (including granulomas, fistula and infections) of tracheostomy and slowly developing consequences as tracheal stenosis. The family physician in charge should be informed in advance about the discharge of a patient with tracheostomy and provided with necessary information or training and hospital contact for referral [16].
14.15 Conclusions
Tracheostomy is a common procedure generally carried out in the intensive care or surgical setting. However, management of a patient with tracheostomy is more ample, because it involves nurses and physician from standard ward, nursing home and the territory in patients discharged at home. Management of routine care and major complication should be known to all actors involved in the process of care and to the patient himself and his caregivers in case of discharge at home. With training, information, checklist and algorithm for management of emergencies, tracheostomy care can be safely taught and achieved.
References
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Related posts:
Choice of the Appropriate Tracheostomy Technique
Complications of Percutaneous and Surgical Tracheostomy in Critically Ill Patients
Tracheostomy: From Surgical to Percutaneous Techniques
Percutaneous Tracheostomy: The Ciaglia Techniques
Airway Management During Tracheostomy
Percutaneous Tracheostomy: The Guide Wire Dilating Forceps Technique
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