From the Guidelines
To manage discomfort after a fresh tracheostomy, proper humidification is essential to prevent dryness and irritation, and it is recommended to use a heat moisture exchanger (HME) or heated humidification system, as stated in the British Thoracic Society guidelines 1. This approach helps maintain a patent tracheostomy tube, reduces the build-up of secretions within the inner tube or the tracheostomy itself, and minimizes any subjective discomfort that the patient may experience. Some key points to consider when managing discomfort after a fresh tracheostomy include:
- Humidification of supplemental oxygen to prevent dryness and irritation
- Regular tracheostomy care, including gentle suctioning as needed and cleaning around the stoma with sterile saline or prescribed solutions
- Positioning the patient with the head of bed elevated 30-45 degrees to reduce pressure and tension on the neck
- The use of pharmacological interventions, such as scheduled acetaminophen and NSAIDs, may also be necessary to manage pain and discomfort, but the primary focus should be on proper humidification and tracheostomy care, as emphasized in the guidelines 1. It is crucial to prioritize the patient's comfort and prevent complications, and the most recent and highest quality study 1 supports the use of humidification as a key component of this approach.
From the Research
Interventions to Help with Discomfort after a Fresh Trach
- Tracheostomy care is a complex nursing activity that requires adequate training and competence to manage potential complications 2.
- Tracheostomy can facilitate the weaning process, reduce the patient's work of breathing, and increase comfort by allowing for a reduction in sedation levels 3.
- Inhalation therapy can be an effective treatment for patients with tracheostomy, but clinicians must understand the factors affecting aerosol drug delivery to optimize therapy 4.
- Humidification is crucial in maintaining adequate humidification of inspired gases, especially in spontaneously breathing tracheostomy patients, with heated humidifiers (HHs) being the most effective method in reducing respiratory complications and improving patient comfort 5.
- Tracheostomy suctioning and humidification are essential aspects of tracheostomy care, and nurses should be aware of the possible complications that may occur as a result of the procedure 6.
Humidification Strategies
- Heat and moisture exchangers (HMEs) may struggle to provide sufficient humidification, particularly when supplemental oxygen is required 5.
- Cool mist humidification (CMH) may be less effective in maintaining adequate humidity levels, requiring more frequent tracheal suctioning due to inadequate humidification 5.
- Heated humidifiers (HHs) consistently provide the highest humidity levels and are the most effective in reducing respiratory complications and improving patient comfort, even with supplemental oxygen 5.
Tracheostomy Care
- Assessment and tracheal suctioning are critical aspects of tracheostomy care, and nurses should be trained to perform these procedures correctly 2, 6.
- The timing of tracheostomy remains a subject of debate, and a personalized approach should be considered to minimize risks and avoid unnecessary delays 3.