Care for a patient with a tracheostomy is carried out in a hospital after the patient is transferred from the intensive care unit. Most often, the tracheostomy is superimposed on the air-conducting paths, if necessary, in mechanical ventilation.
Indications for the procedure
Performing a tracheostomy in the most suitable stationary conditions involves the selection of the optimal method for the preparation of the trachea and thorough homeostasis. Often, endotracheal anesthesia is used for the operation, or a solution of novocaine is applied topically.
The need for an operation for tracheostomy of the respiratory tract arises:
- in case of prolonged mechanical ventilation;
- in the presence of bulbar disorders;
- in the absence of the ability to ensure the free passage of air-conducting paths in another way;
- with low effectiveness of the toilet of the airways;
Technique for performing tracheostomy
An operation for tracheostomy of the respiratory tract requires the presence of several types of scalpels - for dissection of the outer layers of the skin and incision of the trachea. Also during the procedure are used: sliding hooks, skin and muscle expanders, clamps, sterile tampons and napkins.
The patient fits in position on his back with his head thrown back. The skin on the surface of the trachea is disinfected with alcohol, antiseptics, iodine solution and thoroughly wiped with sterile wipes.
During the procedure, a vertical incision is applied starting from the thyroid cartilage to the upper edge of the sternum. Further, in the horizontal direction, the fascia is dissected, after which, using the aforementioned set of medical instruments, the muscles expand and the trachea is released. The trachea is dissected by piercing the scalpel and removing a small flap of tissue sufficient to accommodate the breathing tube.
The free edges of the trachea in the places where the flap is cut off are sutured to the skin, which contributes to the change of tracheostomy tubes. Despite the rather complicated technique for performing a tracheotomy, the procedure is significantly facilitated by preliminary intubation of the patient.
Tube selection
Reliable, thorough care of the tracheostomy in intensive care requires the selection of a suitable tube, the choice of which depends on a number of circumstances. Currently, metal double tubes with a cuff are widely used. It is also possible to use plastic tubes, the pressure in which is stabilized using special cylinders.
The correct selection of a quality tube provides simple care for a tracheostomy in intensive care without causing unnecessary inconvenience to the patient. When choosing the wrong tube, complications often arise in the form of blockage of the lumen with thick, dried mucus. Therefore, her choice should be entrusted to a specialist.
Tracheotomy tube maintenance
In the case of the use of metal cannulas, it is necessary to remove the inner tube at least several times a day for cleaning and processing with antiseptic drugs. At the same time, the outer parts of the cannulas change extremely rarely, not more often than once a week.
The cuff of the cannula for the tracheotomy should not be constantly inflated. Excess air is periodically removed from it and kept asleep for about 10 minutes, after which it is returned to its place. Before proceeding with prophylactic cuff removal, carefully remove any foreign material that has accumulated from the oropharynx.
Features of stoma care
Periodic care of the tracheostomy is carried out using sterile gauze and cotton swabs. The surrounding tissue is cleaned with semicircular movements outward. Further, the tissues are evaluated for complications and infectious lesions.
Caring for a tracheostomy requires replacing the clips if they are excessively moistened or accumulate serious contaminants. The replacement procedure should be carried out if there is assistance. One person holds the handset in a stable position, and his assistant replaces the handset holders.
In the first days after surgery, it is advisable to care for the tracheostomy and peristomal zone with a frequency of 6-8 hours. At the same time, gauze dressings can be regularly replaced as needed. Care products, tools and preparations should always be at hand.
Tracheostomy Care: Algorithm
For the first time, the tube is replaced after a few days after the operation. Moreover, the procedure should be performed by an experienced specialist, since this time is not enough to form a dense stoma.
The algorithm of the procedure :
- the patient is laid on his back and throws back his head;
- complete cleansing of the tracheobronchial opening;
- to remove sputum, a patient artificially causes a cough;
- a flexible catheter is inserted into the cavity of the tube, after which a tracheostomy cannula is removed;
- the tube is replaced, the conductor is removed;
- the new tube is fixed and fixed in a stable position;
Connecting patients with a tracheostomy to a ventilator
Often, care for a patient with a tracheostomy requires the connection of the respiratory tract to the ventilator. Connect the device through a previously installed cannula in the presence of auxiliary connections.
For the purpose of stable connection of the patient to the ventilator, the standard cannula can be replaced with a specially designed tube or a conventional intubation design with an inflatable cuff. The artificial ventilation apparatus itself is connected to the end of the tube with standard, provided devices.
Possible complications
Caring for a tracheostomy often makes you struggle with certain complications, which can occur as soon as the operation is completed, or much later, even if the patient is in a stable condition.
The most common complication is the occurrence of bleeding, especially if a tracheostomy is performed using improvised means urgently, directly at the patient’s bedside. Eliminate heavy pulsating bleeding by compressing the artery with a cuff. However, in order to avoid excessive blood loss, the patient should be provided with emergency medical assistance.
The rules for caring for a tracheostomy require periodic examination of the patient in order to detect a rather serious complication in the form of subcutaneous emphysema. The cause of the latter may be improper installation of the tracheotomy tube.
Another fairly common complication is airway obstruction, which can occur spontaneously, at any time during the patient’s rehabilitation. Most often, the cause of symptoms of obstruction is the formation of a dense plug formed from thick mucus. If the tracheotomy was performed using the internal cannula, then you can fix the problem by cleaning it. Facilitating the patient's condition during obstruction also allows the implementation of vacuum aspiration of the pathways.