What is a tracheostomy?
A tracheostomy is an artificial opening in the neck into the windpipe (trachea). This opening is called a stoma. It allows air to go in and out of the lungs. It also allows any mucus to be removed. A small tube (the tracheostomy tube) is inserted through this opening. Breathing occurs through this tube.
Stroke Candidates for Tracheostomy
The need to tracheostomize a patient with ischemic or hemorrhagic stroke results from the patient’s prolonged inability to breathe and protect his airway sufficiently.
There are two main scenarios in which a tracheostomy (TT) is usually considered. The first is in a patient with a moderate stroke suffering from dysphagia and is found to be at risk of aspiration.
The second scenario is of a patient who suffered from a stroke so severe to make admission to the intensive care unit (ICU) and mechanical ventilation necessary. Here, TT will be chosen as part of weaning from the ventilator.
Tracheostomy Care Nursing in Our Best Stroke Rehabilitation Center
Tracheostomy Tube Management
- Tube Selection and Placement: Choose the appropriate tracheostomy tube size and type based on the patient’s anatomy and clinical needs. Ensure the tube is correctly placed and securely fastened to prevent accidental dislodgement.
- Routine Tube Care: Regularly clean and change the inner cannula (if applicable) to prevent infection and blockage. Monitor the tube for signs of granulation tissue, which could indicate irritation or infection.
Airway Clearance and Secretion Management
- Regular Suctioning: Implement a scheduled suctioning routine to effectively remove respiratory secretions, ensuring the airway remains open and clear.
- Respiratory Assessment: Continuously monitor the patient’s respiratory status, including auscultation of breath sounds, to detect early signs of airway obstruction or respiratory distress.
- Breathing Exercises: Encourage the patient to perform deep breathing and coughing exercises to aid in secretion clearance and promote lung expansion.
Wound Care and Skin Integrity
- Site Maintenance: Keep the tracheostomy site clean and dry, inspecting it regularly for signs of infection, skin breakdown, or pressure injuries.
- Skin Protection: Use appropriate dressings and skin barriers to skin from irritation. Change dressings as needed to maintain hygiene and comfort.
- Patient Education: Teach the patient and caregivers proper wound care techniques, including signs of complications to watch for, such as increased redness, swelling, or unusual discharge.
Communication and Swallowing Management
- Communication Support: Assess the patient’s ability to communicate and provide alternative methods, such as communication boards, writing pads, or referral to a speech therapist if necessary.
- Swallowing Assessment: Evaluate the patient’s swallowing ability, and implement precautions or dietary modifications to prevent aspiration and choking. Work with speech-language pathologists to tailor interventions to the patient’s needs.
Tracheostomy Tube Care
- Daily Cleaning: Clean the outer surface of the tracheostomy tube daily using mild soap and water, ensuring thorough rinsing to avoid irritation or infection.
- Dressing Changes: Regularly change the tracheostomy dressing to prevent infection and skin irritation. Ensure the site remains dry and clean.
- Cuff Pressure Monitoring: If the tracheostomy tube has a cuff, monitor and maintain the cuff pressure within the recommended range to prevent tracheal injury.
Assistance with Eating and Drinking
- Feeding Assistance: Assist with feeding and drinking as needed, based on the patient’s condition and swallowing ability. Position the patient properly to reduce the risk of aspiration.
- Dietary Modifications: Offer thickened liquids or modified diets as the speech-language pathologist or dietitian recommends, ensuring that the patient’s nutritional needs are safely met.
Addressing the Challenges of Dry Air
- Use humidification devices, such as a humidifier or nebulizer, to moisten the inspired air and prevent airway dryness.
- Encourage adequate fluid intake to maintain hydration and mucous membrane integrity.
- Monitor for signs of airway dryness, such as thick secretions or discomfort, and adjust humidification as needed.
Complication Management
- Nurses are trained to recognize and manage common complications associated with tracheostomy, such as tube obstruction, infection, or granulation tissue formation.
- Prompt intervention and collaboration with the interdisciplinary team help prevent adverse outcomes and promote patient recovery.
Patient and Caregiver Education
- Nurses provide comprehensive instructions on tracheostomy care techniques, including suctioning, tube changes, and emergency procedures.
- Written materials and resources are provided for reference, and any questions or concerns are addressed to ensure understanding and compliance.
At our best stroke rehabilitation center Nurses are vital in managing stroke patients with tracheostomies, ensuring airway patency, preventing complications, and supporting recovery.
Tracheostomy care nursing responsibilities include routine tube care, airway clearance, wound management, and addressing challenges like dry air.
Through vigilant monitoring and patient education, nurses help ensure safe and effective care, significantly enhancing the quality of life and outcomes for these patients.
