From the Guidelines
The recommended assessment for a patient with a tracheostomy should include regular evaluation of the tracheostomy site, tube patency, and respiratory status, with a focus on preventing complications such as tube obstruction, accidental decannulation, tracheal stenosis, and infection, as outlined in the most recent guidelines 1. When assessing a patient with a tracheostomy, it is essential to begin by evaluating the stoma for signs of infection, granulation tissue, or bleeding. The tracheostomy tube position should be checked to ensure it is secure with clean ties or holder.
Key Assessment Components
- Suctioning as needed using aseptic technique with a catheter that is no more than half the internal diameter of the tube, applying suction only during withdrawal for no more than 10-15 seconds.
- Cleaning the inner cannula at least daily or more frequently if secretions are thick, using sterile saline or hydrogen peroxide diluted 1:1 with sterile water.
- Changing the dressing around the stoma daily using sterile technique, and replacing the entire tracheostomy tube according to manufacturer recommendations, typically every 4-8 weeks for long-term users.
- Maintaining emergency equipment at bedside, including spare tracheostomy tubes (same size and one size smaller), suction equipment, and resuscitation supplies, as emphasized in 1 and 1.
Management Plan
The management plan should prioritize preventing complications and ensuring the patient's airway is secure. This includes:
- Humidification to prevent mucus plugging, using either a heat and moisture exchanger (HME) for mobile patients or heated humidification for those requiring continuous support.
- Monitoring for complications such as tube obstruction, accidental decannulation, tracheal stenosis, and infection, with a focus on early detection and intervention.
- Maintaining a comprehensive approach to tracheostomy care, including regular evaluation and management of the tracheostomy site, tube patency, and respiratory status, as outlined in 1 and 1. By following this approach, healthcare providers can help ensure the best possible outcomes for patients with tracheostomies, minimizing the risk of complications and promoting optimal morbidity, mortality, and quality of life outcomes.
From the Research
Assessment of a Patient with a Tracheostomy
The assessment of a patient with a tracheostomy involves several key components, including:
- Evaluation of the tracheostomy site for signs of infection, bleeding, or other complications 2, 3
- Assessment of the patient's respiratory status, including oxygen saturation, respiratory rate, and lung sounds 4, 5
- Evaluation of the patient's ability to communicate, including the use of speaking valves or other alternative communication methods 4, 5
- Assessment of the patient's nutritional status, including the ability to eat and drink safely with a tracheostomy tube in place 4, 5
Management Plan for a Patient with a Tracheostomy
The management plan for a patient with a tracheostomy should include:
- Regular cleaning and maintenance of the tracheostomy site and tube 2, 3
- Monitoring for signs of complications, such as infection, bleeding, or respiratory distress 2, 3
- Use of tracheostomy bundles and protocols to guide care and reduce the risk of complications 4
- Collaboration with a multidisciplinary team, including nurses, respiratory therapists, and physicians, to provide comprehensive care 4, 5
- Development of a weaning and decannulation plan to guide the removal of the tracheostomy tube when appropriate 4
Nursing Care for a Patient with a Tracheostomy
Nursing care for a patient with a tracheostomy should include:
- Providing education to the patient and family on tracheostomy care and management 3, 5
- Assisting with tracheostomy tube changes and cleaning 2, 3
- Monitoring for signs of complications and reporting concerns to the healthcare team 2, 3
- Collaborating with the healthcare team to develop and implement a plan of care that meets the patient's individual needs 4, 5