What is the follow-up care for a patient after a tracheostomy?

Follow-up Care After Tracheostomy

The most comprehensive follow-up care for a patient after tracheostomy should include regular tube securement, stoma care, suctioning, and monitoring for complications to reduce morbidity and mortality. 1

Immediate Post-Tracheostomy Care

• Ensure proper tube securement using either twill ties or foam straps (foam straps are preferred as they reduce skin breakdown and require less frequent assessment) 1
• Remove sutures used to secure the tracheostomy tube within 7-10 days after placement, preferably before discharge 1
• Assess the need for tracheostomy dressings daily, changing them only when soiled to minimize tube manipulation 1
• Use disposable inner cannulas when possible to avoid risks associated with cleaning reusable ones 1

Routine Tracheostomy Care

Suctioning and Secretion Management

• Implement regular suctioning to prevent mucus buildup and airway obstruction, which is one of the most common reasons for airway emergencies 1
• Use proper suctioning technique with pre-marked catheters and twirl the catheter between fingertips during suctioning 1
• Ensure suction equipment is readily available at all times, including a battery-operated suction machine for home care or transport 1
• For patients with Pseudomonas colonization in secretions, consider nebulized antibiotics such as tobramycin or colistin as recommended by the European Respiratory Society 2

Stoma and Skin Care

• Keep the skin clean and dry to prevent pressure necrosis and infection 1
• Clean the peristomal area daily with soap and water; use 1.5% hydrogen peroxide only for encrusted secretions, followed by thorough rinsing and drying 1
• Inspect the peristomal area and neck skin daily for signs of breakdown or infection 1
• Avoid routine use of ointments and creams; petroleum-based products are contraindicated 1
• Consider products like Duoderm to cushion the skin beneath tracheostomy ties for patients at high risk of skin breakdown 1

Transport and Safety Considerations

• During transport, equip non-ventilated patients with a heat moisture exchange (HME) device with viral filter 1
• For mechanically ventilated patients, maintain optimal cuff inflation with a closed circuit during transport 1
• Have surgical masks cover both the patient's face and tracheostomy tube during transport 1
• Ensure emergency equipment accompanies the patient at all times, including a functional suctioning system, oxygen source, manual resuscitation bag, and complete tracheostomy kit 3

Medication Administration

• Avoid jet nebulizers for medication delivery as they can increase aerosolization 1
• For non-mechanically ventilated patients, use a spacer for delivery of metered-dose inhaled medications 1
• For mechanically ventilated patients, use vibrating mesh nebulizers that don't require disconnection of closed-circuit systems 1

Complication Monitoring and Management

High-Risk Complications to Monitor

• Tube obstruction from mucus plugging (requires immediate intervention) 1, 4
• Accidental decannulation or tube displacement 4
• Bleeding or hemorrhage around the stoma 4
• Infection at the stoma site 4
• Tracheal stenosis or tracheomalacia with prolonged tracheostomy use 4

Environmental Safety Measures

• Avoid exposure to dust, smoke, lint, pet hair, powder, sprays, and small objects 1
• Restrict contact with fuzzy toys, clothes, or bedding 1
• Avoid contact sports and water sports; bathing should be limited to 1-2 inches of water with a trained caretaker present 1

Long-Term Follow-up and Decannulation Planning

• Establish regular follow-up appointments with the healthcare team 1, 5
• Develop a projected decannulation plan based on resolution of the original need for tracheostomy and ability to maintain a safe airway 1
• Consider traditional decannulation technique (sequential downsizing with tube plugging) or one-stage decannulation procedure based on patient assessment 1
• Prepare for possible surgical closure if spontaneous closure of the stoma doesn't occur after decannulation 1

Education and Training

• Begin patient and caregiver education as early as possible, ideally before the tracheostomy procedure 5
• Ensure caregivers can demonstrate proper tube changing technique, including emergency reinsertion procedures 1, 5
• Train caregivers in CPR specific to tracheostomy patients 1
• Ensure telephone services are available and local emergency services are notified about the patient's condition 1

By following this comprehensive approach to tracheostomy follow-up care, healthcare providers can minimize complications and optimize outcomes for patients with tracheostomies.