Tuesday, November 30, 2010

Tracheostomy Care

  1. Three things are needed for tracheostomy tube change : Proper light, good suction, proper position of patient. if possible make the patient lie on a bed with cushion under the shoulder so that front of neck gets exposed adequately. keep a good light above the stoma and keep suction ready. before taking the tube out, keep the new tube ready with the jelly smeared over its cuff. Remove the tube gently following the curvature and then inspect the stoma. Do not make haste here and do not delay the insertion of new tube unnecessarily also. put the new tube under vision and not just blindly.
  2. Ideally tracheostomy tube should be changed daily. because it avoid formation of a layer above the tube also known as SUPRASTOMAL LEDGE that otherwise may delay the decannulation process. 
  3. No need to inflate the cuff unless patient is aspirating (i.e. liquids are going to windpipe from the mouth) or patient is unconscious. If cuff has to be inflated, then its pressure has to be kept below 20 mmHg otherwise the wall of windpipe may be damaged because of continuous pressure.
  4. In country like ours, it's not practical to ask for purchase of new tube every time. Better, reuse the tube after thoroughly washing it running water and then keeping it in Cidex or boiling it. Portex tube may last many weeks with this.
  5. It's better to show it to ENT Specialist in case of tight fitting, bleeding from the stoma.

You can post your question or suggestion in comment section regarding tracheostomy.

Dr. Ajay Jain

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