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Don’t Panic, if the tracheostomy falls out

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A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube called as tracheostomy tube or trach tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. The tracheostomy may allow the patient to come off the ventilator more quickly and may be more comfortable. Later, it can be taken off when the patient is able to breathe well without the help of the ventilator.

Guidelines for Nursing Care of the Tracheostomy Patient:
Three major factors must be considered in the care of the tracheostomy patient:
1. Humidification
2. Mobilization of secretions
3. Airway patency.

Humidity
The importance of humidification can not be overemphasized. The nasopharynx, which provides the natural humidification mechanism for the airway, has been bypassed by tracheostomy. It is absolutely essential that adequate humidity be provided to keep the airway moist.

Mobilization of Secretions
Many of the nursing skills employed are aimed at the mobilization of pulmonary secretions. Frequent turning, encouragement of deep breathing, and ambulation are important in the prevention of pulmonary complications.

Suctioning
Suctioning is done only for patients who can’t clear their own airways depending on each and different patient rather than performed on a set schedule.Start with a complete assessment like increased work of breathing, changes in respiratory rate, decreased oxygen saturation, copious secretions, wheezing, and the patient’s unsuccessful attempts to clear secretions..

COMPLICATIONS OF tracheostomy:
• Aspiration
• Haemorrhage
• Air embolism
• Failure of procedure
• Structural damage to tracheal rings

IF THE TRACHEOSTOMY TUBE FALLS OUT !!…

  • DON’T PANIC!
  • Once the tracheostomy tube has been in place for about 5 days the tract is well formed and will not suddenly close.
  • Reassure the patient
  • Call for medical help.
  • Ask the patient to breathe normally via their stoma while waiting for the doctor.
  • The stay suture (if present) or tracheal dilator may be used to help keep the stoma open if necessary.
  • Stay with patient.
  • Prepare for insertion of the new tracheostomy tube
  • Once replaced, tie the tube securely, leaving one finger-space between ties and the patient’s neck.
  • Check tube position by (a) asking the patient to inhale deeply – they should be able to doso easily and comfortably, and (b) hold a piece of tissue in front of the opening – it should be “blown” during patient’s exhalation.

 

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