Tracheostomy: Overview and Practice Questions (2024)

A tracheostomy is a medical procedure in which a surgical opening is created in the neck to provide an airway and remove secretions from the lungs.

This procedure is typically performed when a person is unable to breathe normally due to an obstruction, long-term ventilation requirements, or other respiratory conditions.

This article provides an overview of a tracheostomy, including the procedure, indications for insertion, and potential complications.

What is a Tracheostomy?

A tracheostomy is a medical procedure in which a surgeon creates an opening (stoma) through the neck into the trachea (windpipe). This opening provides an alternative airway for breathing when a person’s usual breathing path is blocked or impaired.

A tube, called a tracheostomy tube, is placed into the stoma to maintain the opening and allow air to pass directly into the lungs.

Indications

Indications for a tracheostomy include a variety of conditions and situations where a patient’s airway is compromised and alternative respiratory support is needed.

The primary indications include:

• Airway Obstruction: Upper airway obstruction caused by conditions like tumors, trauma, infections, or congenital abnormalities that block or narrow the airway, preventing normal breathing.
• Prolonged Mechanical Ventilation: For patients who require extended mechanical ventilation (typically more than 1-2 weeks), a tracheostomy is often performed to reduce the risk of complications associated with prolonged use of an endotracheal tube, such as vocal cord damage or airway injury.
• Neurological Impairment: Patients with neurological conditions (e.g., stroke, spinal cord injury, or neuromuscular diseases such as ALS) that result in the inability to protect the airway or effectively control breathing often need a tracheostomy to maintain airway patency and assist with ventilation.
• Secretion Management: A tracheostomy is used in patients who have difficulty clearing respiratory secretions due to conditions like cystic fibrosis, bronchiectasis, or chronic obstructive pulmonary disease (COPD), as it facilitates suctioning and better airway clearance.
• Trauma: Severe trauma to the face or neck (e.g., fractures, burns, or penetrating injuries) can obstruct the airway, necessitating a tracheostomy to bypass the injury and maintain a patent airway.
• Airway Protection: In patients at risk for aspiration (e.g., those with severe swallowing disorders or reduced consciousness), a tracheostomy may be performed to help prevent aspiration of food, liquids, or secretions into the lungs.
• Congenital Abnormalities: Infants or children with congenital abnormalities such as laryngomalacia, tracheomalacia, or subglottic stenosis that cause chronic airway obstruction may require a tracheostomy for long-term airway support.
• Anaphylaxis or Severe Allergic Reactions: In emergencies, where swelling of the airway due to anaphylaxis causes obstruction, a tracheostomy may be performed when other interventions (such as intubation) fail.
• Inhalation Injury: Severe inhalation injuries, such as burns from smoke or chemicals, can cause swelling and obstruction of the upper airway, necessitating a tracheostomy.

Note: These indications are often determined by a multidisciplinary team, including respiratory therapists, surgeons, and critical care physicians, based on the patient’s specific needs and clinical condition.

Risks and Complications

A tracheostomy, like any medical procedure, carries certain risks and complications that can occur both during and after the procedure.

These risks can be categorized into early and late complications:

Early Complications

• Bleeding: While minor bleeding is common, excessive or prolonged bleeding can become a serious complication, requiring prompt medical attention.
• Pneumothorax: Occurs when air leaks into the space between the lung and the chest wall, potentially causing lung collapse, which may require chest tube placement to resolve.
• Injury to Surrounding Structures: Damage to nearby tissues such as the esophagus, blood vessels, or nerves can occur during the procedure, leading to further complications.
• Tube Misplacement: The tracheostomy tube may accidentally be placed in the wrong location, such as between the tracheal rings or even into the esophagus, which can lead to airway compromise.
• Subcutaneous Emphysema: Air can become trapped under the skin around the tracheostomy site, causing visible swelling and discomfort. This may resolve on its own or require intervention.
• Air Embolism: Although rare, air can sometimes enter the bloodstream, potentially leading to life-threatening complications like an air embolism.
• Infection: Infections can develop at the stoma site, which may progress to more severe conditions like tracheitis or pneumonia if not properly managed.

Late Complications

• Tracheal Stenosis: Scarring and narrowing of the trachea can develop over time, making it difficult for air to pass through the airway.
• Tracheomalacia: Prolonged pressure from the tracheostomy tube can lead to softening of the tracheal walls, causing them to collapse and obstruct airflow.
• Granulation Tissue: Over time, excess scar tissue may form around the tracheostomy site, which can interfere with breathing by partially blocking the airway.
• Tracheo-esophageal Fistula: An abnormal passage may form between the trachea and the esophagus, allowing food or liquids to enter the airway, leading to aspiration and infection.
• Tube Blockage: Mucus, blood, or tissue can obstruct the tube, making breathing difficult and requiring immediate cleaning or replacement.
• Tube Displacement: The tracheostomy tube may shift out of place or become completely dislodged, which can lead to airway obstruction and an emergency situation.
• Tracheocutaneous Fistula: A persistent abnormal opening may develop between the trachea and the skin, particularly after the tube is removed, which may require surgical repair.
• Chronic Infection: Long-term infections may develop at the tracheostomy site or in the lower airways, leading to recurrent respiratory complications.
• Difficulty Swallowing: Some patients may experience dysphagia (difficulty swallowing) as a result of their tracheostomy, potentially increasing the risk of aspiration.
• Cosmetic Concerns: Once the tracheostomy tube is removed, patients may be left with a visible scar or indentation at the site, which may impact their appearance and self-esteem.

Note: It’s crucial for healthcare providers to be aware of these potential complications and educate patients and caregivers about the warning signs to watch for. Regular follow-up and proper tracheostomy care can significantly reduce many of these risks, ensuring better long-term outcomes for patients.

Parts of a Tracheostomy Tube

A tracheostomy tube is a sophisticated medical device made up of several key components, each serving a specific purpose to support breathing and ensure patient safety. Understanding these parts is essential for proper care and maintenance.

Here are the primary parts of a tracheostomy tube:

• Outer Cannula: The main structure of the tracheostomy tube that is inserted into the trachea. It provides the primary airway for airflow and remains in place within the trachea.
• Inner Cannula: A removable tube that fits inside the outer cannula. This part can be cleaned or replaced regularly, ensuring that the airway stays open without the need to remove the entire tracheostomy tube.
• Cuff: A balloon-like feature around the outer cannula that can be inflated to create a seal against the tracheal walls. This prevents air leakage during mechanical ventilation and helps protect against aspiration of secretions into the lungs.
• Pilot Balloon: A small external balloon connected to the cuff via a thin line. It acts as an indicator, showing whether the cuff is inflated or deflated by its firmness or softness.
• Cuff Inflation Line: A narrow tube that connects the pilot balloon to the cuff, allowing for the inflation or deflation of the cuff with air, controlling the airway seal as needed.
• Obturator: A solid, rounded guide used to insert the tracheostomy tube safely into the trachea. Once the tube is in place, the obturator is removed, leaving the airway open for breathing.
• Flange (Neck Plate): A flat piece attached to the outer cannula that sits against the neck. It features openings for ties or Velcro bands, which secure the tube in place to prevent movement.
• Fenestrations: Small holes located on the outer cannula (above the cuff, if present) in some tracheostomy tubes. These openings allow the patient to breathe through both the tube and the fenestrations when the inner cannula is removed, facilitating speech and aiding in the weaning process.

Note: Understanding the different parts of a tracheostomy tube is critical for healthcare providers, caregivers, and patients. Proper knowledge helps ensure the device is used, maintained, and cleaned effectively, reducing the risk of complications and improving patient care.

Types of Tracheostomy Tubes

Tracheostomy tubes are available in various types, each tailored to meet specific clinical needs and patient requirements.

Here are the primary types:

• Cuffed Tracheostomy Tubes: These tubes feature an inflatable cuff around the outer cannula, which seals the airway when inflated. This ensures that air is directed solely through the tube, making them ideal for patients on mechanical ventilation or those at risk of aspiration.
• Uncuffed Tracheostomy Tubes: Lacking an inflatable cuff, these tubes are typically used in patients who do not require a sealed airway, such as pediatric patients or adults who can manage their own secretions and are not on mechanical ventilation.
• Fenestrated Tracheostomy Tubes: These tubes have small openings, or fenestrations, in the outer cannula. When the inner cannula is removed, the patient can breathe through both the tube and the fenestrations, which allows for improved speech and the potential for weaning off the tracheostomy tube.
• Shiley Tracheostomy Tubes: A widely recognized brand, Shiley tubes offer standardized designs with a range of sizes and features, including cuffed, uncuffed, and fenestrated options to suit various patient needs.
• Metal (Silver) Tracheostomy Tubes: Made from durable materials like silver, these rigid tubes are often used for long-term tracheostomies. They are less flexible but offer a longer lifespan and reduced risk of infection compared to plastic tubes.
• Double Cannula Tracheostomy Tubes: These tubes consist of an outer cannula that remains in place and a removable inner cannula that can be easily cleaned or replaced. This design enhances hygiene and maintenance, reducing the risk of blockages.
• Single Cannula Tracheostomy Tubes: Unlike double cannula tubes, these lack a removable inner cannula, making them a more straightforward option but with less flexibility for cleaning and maintenance.
• Adjustable Flange Tracheostomy Tubes: These tubes feature adjustable flanges that allow for modification of the tube’s length inside the trachea. They are especially useful for patients with atypical neck anatomy or varying tracheal depths.
• Pediatric and Neonatal Tracheostomy Tubes: Designed specifically for children and newborns, these tubes are smaller and more flexible to accommodate delicate airways while ensuring safety and comfort.
• Tracheostomy Tubes with Speaking Valves: These specialized tubes include speaking valves that enable airflow over the vocal cords, allowing patients to speak while using the tracheostomy tube. This improves communication and quality of life for patients who require long-term ventilation.

Note: Each type of tracheostomy tube serves a unique purpose based on the patient’s clinical condition, anatomy, and treatment goals. Choosing the appropriate tube is critical for ensuring optimal patient outcomes and comfort.

Tracheostomy Tube Suctioning

Tracheostomy tube suctioning is an essential procedure for clearing secretions from the airway to maintain patency, promote proper ventilation, and prevent respiratory distress.

This helps minimize the risk of infection and other complications associated with secretion buildup. Effective suctioning ensures the airway remains open, promoting better oxygenation and overall respiratory function.

Procedure

• Hand Hygiene and Precautions: Begin by thoroughly washing your hands. If you are a healthcare provider or caregiver, wear gloves, and in some cases, additional protection like a mask and eye shield to prevent infection.
• Equipment Preparation: Gather all required materials, including a suction catheter, suction machine (or manual device), sterile saline (if needed to moisten the catheter), and a clean container for waste.
• Pre-Oxygenate the Patient: Before suctioning, provide the patient with supplemental oxygen for a few minutes. This is particularly important in hospital settings to ensure the patient maintains proper oxygen levels during the procedure.
• Turn On and Adjust the Suction Machine: Set the suction pressure to a safe level. For adults, this is typically between 80-120 mmHg.
• Inserting the Suction Catheter: Gently insert the catheter into the tracheostomy tube without applying suction. Advance it carefully until you feel resistance or the patient coughs, indicating it has reached the appropriate depth. Pull back slightly before applying suction.
• Applying Suction: Apply intermittent suction as you withdraw the catheter, covering and releasing the suction control opening. Rotate the catheter between your fingers while pulling it out to ensure thorough removal of secretions from all sides of the trachea. The entire process should not exceed 10-15 seconds.
• Post-Suctioning Oxygenation: After suctioning, administer supplemental oxygen to the patient again to help stabilize oxygen levels.
• Repeat if Necessary: If secretions are still present, repeat the suctioning process. Allow the patient to rest for 1-2 minutes between attempts to avoid fatigue and ensure recovery.
• Dispose of Materials: Safely discard the used suction catheter and other disposable items. Clean and disinfect any reusable equipment following the facility’s protocol.
• Monitor the Patient: After suctioning, carefully observe the patient for signs of improvement, such as easier breathing and improved oxygen saturation, as well as any signs of distress.

Considerations

• Frequency: Suctioning should only be performed when necessary (PRN). Over-suctioning can irritate the airway, while insufficient suctioning may lead to blockages and respiratory complications.
• Sterile Technique: In hospital environments, using a sterile technique is crucial to prevent infections. Always ensure the procedure is performed in a clean, controlled environment.
• Potential Complications: Suctioning can cause certain complications, including hypoxia (low oxygen levels), trauma to the tracheal lining, bleeding, infection, and in rare cases, cardiac arrhythmias triggered by vagus nerve stimulation.

Note: Proper training and familiarity with the suctioning technique and equipment are essential for anyone performing tracheostomy care.

What is Tracheostomy Care?

Tracheostomy care refers to the regular cleaning and maintenance of the tracheostomy site and tube to ensure the patient’s safety, comfort, and well-being.

Proper care is crucial to preventing infections, maintaining skin integrity, ensuring the airway remains open, and prolonging the functionality of the tracheostomy equipment.

Steps to Performing Tracheostomy Care

• Cleaning the Stoma Site: Clean around the tracheostomy opening (stoma) using sterile saline or a prescribed cleaning solution with sterile cotton swabs or gauze. Examine the skin for any signs of infection, irritation, or breakdown, such as redness, swelling, or discharge. Dry the area thoroughly to prevent moisture buildup, which can cause skin breakdown.
• Changing the Dressing: Apply a split gauze or a tracheostomy-specific dressing around the stoma to absorb moisture or secretions. Change the dressing at least once a day or as often as necessary, particularly if it becomes wet or soiled. This helps keep the area dry and clean, reducing the risk of infection.
• Suctioning: As previously discussed, suctioning is performed to remove secretions from the tracheostomy tube and trachea. This keeps the airway clear and helps prevent respiratory complications.
• Inner Cannula Care: For tracheostomy tubes with a removable inner cannula, remove and clean it with a prescribed solution. In the case of disposable inner cannulas, replace them with a new one as needed. This prevents blockages and maintains airway patency.
• Cuff Care: If the tracheostomy tube has a cuff, monitor its pressure regularly to ensure proper inflation. Adjust the cuff based on medical advice and the patient’s condition, ensuring a balance between maintaining a seal and avoiding excessive pressure on the trachea.
• Changing Tracheostomy Ties: The tracheostomy tube is secured in place with ties or Velcro bands. Ensure they are snug but not too tight—you should be able to fit one or two fingers between the ties and the patient’s neck. Change the ties if they become soiled, loose, or frayed to ensure the tube remains securely in place.
• Tube Changes: Routine tracheostomy tube changes are necessary to ensure the tube’s patency and prevent wear and tear. The frequency of tube changes varies based on the patient’s condition, the type of tube, and age. Always have a replacement tube of the same size and one size smaller available during the change in case of an emergency.
• Monitoring and Education: Continuously monitor the patient’s breathing and comfort during and after tracheostomy care. Look for signs of complications such as infection or obstruction. Educate patients and caregivers on recognizing early warning signs and how to manage the tracheostomy effectively.
• Humidification: A tracheostomy bypasses the body’s natural humidification processes, so it’s essential to provide humidity using a humidifier or mist collar. This prevents the drying out of secretions, which could lead to blockages and make suctioning more difficult.

Considerations

• Frequency: Daily tracheostomy care is vital, but certain tasks, like suctioning, may need to be performed more frequently depending on the patient’s needs and condition.
• Infection Prevention: Always use clean, sterile techniques when caring for the tracheostomy, particularly in hospital settings. This minimizes the risk of introducing infections.
• Patient Comfort: Ensure the patient is comfortable and informed throughout the care process. Promptly address any discomfort or concerns they may have during the procedure.

Note: Regular, thorough tracheostomy care significantly reduces the risk of complications such as infections, skin breakdown, or airway obstruction. Proper care helps ensure the longevity of the tracheostomy tube and improves the patient’s overall quality of life.

Tracheostomy Practice Questions

1. What is a tracheostomy?
A tracheostomy is a surgically created opening (stoma) in the trachea that establishes an airway for breathing.

2. When is a tracheostomy typically used?
A tracheostomy is used when a patient requires long-term airway support, has an upper airway obstruction, or needs prolonged mechanical ventilation.

3. What are the advantages of a tracheostomy compared to an endotracheal tube?
A tracheostomy provides a more secure airway, increases patient mobility, reduces the risk of long-term airway damage, allows easier breathing, enhances comfort, and enables the patient to eat and speak.

4. What are the primary parts of a tracheostomy tube?
The main components of a tracheostomy tube include the faceplate (flange), outer cannula, inner cannula (if present), obturator, and cuff. The pilot balloon is used to monitor cuff inflation. Cuffed and uncuffed variations are available to suit different patient needs.

5. What is the purpose of the obturator in a tracheostomy tube?
The obturator is used to guide the tracheostomy tube into position during insertion and is immediately removed to allow airflow once the tube is properly placed.

6. What is involved in routine tracheostomy care?
Routine tracheostomy care includes cleaning the stoma site, changing the dressing, suctioning secretions, cleaning the inner cannula, checking cuff pressure, and changing ties or securing devices as necessary.

7. How is the inner cannula cleaned?
To clean the inner cannula, gather the necessary equipment, don sterile gloves, remove the inner cannula, clean it with a prescribed solution, rinse it with sterile saline, and reinsert it into the outer cannula.

8. When is a cuffed tracheostomy tube used?
A cuffed tracheostomy tube is used when the patient is at risk for aspiration or requires mechanical ventilation, as the cuff seals the airway and prevents secretions from entering the lungs.

9. What is the recommended cuff pressure for a tracheostomy tube?
The recommended cuff pressure is between 20-25 cm H2O to maintain a proper seal and prevent tracheal damage.

10. What is the minimal leak technique (MLT) for cuff inflation?
The MLT involves inflating the cuff until a seal is achieved and then withdrawing 0.1 mL of air to allow a slight leak, unless the patient is at risk for aspiration.

11. When should the cuff of a tracheostomy tube be deflated?
The cuff should be deflated if the patient is not at risk for aspiration, which allows for easier swallowing and speaking. Suction the patient before and after deflation to prevent secretions from entering the lungs.

12. What precautions should be taken to prevent accidental tracheostomy tube dislodgement?
Keep a replacement tube at the bedside, avoid changing ties for the first 24 hours after insertion, and have a physician perform the first tube change.

13. What should be done if a tracheostomy tube is accidentally dislodged?
Attempt to reinsert the tube immediately. If unable to do so, insert a suction catheter to maintain airflow until the tube is replaced. If reinsertion is not possible, cover the stoma with a sterile dressing and use a bag-mask to ventilate the patient until help arrives.

14. How does an inflated cuff affect swallowing?
An inflated cuff can interfere with the normal function of swallowing muscles, increasing the risk of dysphagia and aspiration.

15. What is a speaking tracheostomy tube?
A speaking tracheostomy tube has dual pigtail tubings: one for cuff inflation and another for delivering low-flow air above the cuff, allowing the patient to speak.

16. What is a fenestrated tracheostomy tube, and how is it used?
A fenestrated tracheostomy tube has openings in the outer cannula that allow air to pass into the upper airway, enabling speech. The inner cannula is removed, the cuff is deflated, and a cap is placed on the tube.

17. What are the criteria for tracheostomy tube decannulation?
Decannulation is considered when the patient can effectively exchange air, clear secretions, and maintain airway stability without the tube.

18. What should be done after decannulation?
The stoma should be closed with tape and an occlusive dressing. The patient should splint the incision when coughing, swallowing, or speaking. The stoma typically closes within 4-5 days.

19. What are speaking valves, and how do they work?
Speaking valves are thin diaphragms that open during inspiration and close during expiration, directing air through the vocal cords for speech. The cuff must be deflated or a cuffless tube must be used.

20. What communication tools can be provided for tracheostomy patients without speaking devices?
Patients can use communication tools such as a magic slate, picture boards, alphabet boards, or paper and pencil for communication.

21. The patient with a tracheostomy who cannot protect the airway from aspiration requires what type of cuff?
A patient who cannot protect the airway requires an inflated cuff to prevent aspiration and ensure a sealed airway.

22. What are the primary purposes of a tracheostomy?
A tracheostomy is used to establish a patent airway, bypass an airway obstruction, facilitate secretion removal, permit long-term mechanical ventilation, and aid in weaning from mechanical ventilation.

23. What are the advantages of a tracheostomy compared to an endotracheal tube?
A tracheostomy is easier to keep clean, allows for better oral and bronchial hygiene, increases patient comfort, and reduces the risk of long-term damage to the vocal cords.

24. What management is included for a patient with a tracheostomy?
Acute care involves explaining the procedure to the patient and preparing them for operating room or bedside insertion.

25. What should you do to prepare for the bedside insertion of a tracheostomy?
You should record vital signs, ensure the existing IV is patent, assess bedside suction, position the patient supine, and administer analgesia and/or sedation.

26. What post-procedure care should be performed for a patient with a new tracheostomy?
Remove the obturator and keep it at the bedside, inflate the cuff (balloon), auscultate for air entry, and ensure the tracheostomy is sutured in place and secured.

27. What are the key assessment priorities after a tracheostomy is placed?
Assessment priorities include airway patency, lung sounds, need for suctioning, bleeding around the tracheostomy, mechanical ventilator settings, and neurologic status.

28. What emergency equipment should be available at the bedside for a patient with a tracheostomy?
A tracheostomy setup, a second tracheostomy tube (same size), forceps, the obturator from the current tracheostomy tube, and suction equipment should be available at the bedside.

29. What care should be provided for a patient with a tracheostomy?
Care includes assessing respiratory status, suctioning as needed, positioning the patient with the head of bed elevated 30-40 degrees, providing humidified air, ensuring adequate hydration, and providing frequent stoma and inner cannula care.

30. Why should a second person assist with changing tracheostomy ties?
One person should stabilize the tracheostomy while the other changes the ties to prevent accidental dislodgement.

31. How long should suction time be limited to during tracheostomy care?
Suction time should be limited to 10 seconds to prevent hypoxia and mucosal damage.

32. When is a tracheostomy tube with an inflated cuff used?
An inflated cuff is used if the patient is at risk of aspiration or requires mechanical ventilation.

33. What is the recommended maximum cuff pressure to prevent tracheal necrosis?
The cuff pressure should not exceed 20-25 cm H2O to avoid compressing tracheal capillaries and limiting blood flow.

34. During which time period is the risk of tracheostomy tube dislodgement the highest?
The most dangerous time is the first 5-7 days when the stoma is not yet mature.

35. What precautions can be taken to prevent accidental tracheostomy tube dislodgement?
Keep a replacement tube at the bedside, avoid changing ties for 24 hours, and ensure that a physician performs the first tube change.

36. What should you do in case of accidental dislodgement of the tracheostomy tube?
Call for help immediately.

37. What should you do if the tracheostomy tube cannot be replaced?
Assess the level of respiratory distress. If minor, position the patient in a semi-Fowler’s position. Severe distress may progress to respiratory arrest—cover the stoma with a sterile dressing and ventilate with a bag-valve mask until help arrives.

38. Twenty-four hours after a tracheostomy, the tube is accidentally dislodged after the patient coughs. Which action should you take first?
You should first grasp the retention sutures to spread the tracheostomy opening, ensuring the airway remains accessible for reinsertion.

39. How often should a tracheostomy tube be changed after the initial replacement?
A tracheostomy tube should be changed every month to maintain patency and prevent complications.

40. What should you teach a patient with a tracheostomy?
Teach the patient how to observe the tracheostomy site, clean the inner cannula, suction as needed, and change the tracheostomy tapes.

41. What type of cuff should a tracheostomy patient without aspiration risk use?
If there is no risk of aspiration, the patient should use a deflated cuff or a cuffless tube.

42. What communication tools can be provided for tracheostomy patients without speaking devices?
Patients can use paper and pencil, a whiteboard, a magic slate, picture boards, or a visual alphabet for communication.

43. What techniques promote speech in a patient with a tracheostomy?
Techniques include deflating the cuff (for spontaneously breathing patients), using specialized tracheostomy tubes, or utilizing speaking valves.

44. How does a fenestrated tracheostomy tube work?
A fenestrated tracheostomy tube allows air to pass from the lungs through openings in the tube into the upper airway, enabling speech. It must not be used if the patient is at risk for aspiration.

45. What should you assess before removing a tracheostomy tube?
You should assess the patient’s ability to exchange air and expectorate secretions before removing the tube.

46. How should you care for the stoma after a tracheostomy tube is removed?
Close the stoma with tape and apply an occlusive dressing. Change the dressing if it becomes soiled or wet. The stoma should close within 4 to 5 days.

47. When can a tracheostomy be removed?
A tracheostomy can be removed once the patient is hemodynamically stable, has an intact respiratory drive, and can adequately exchange air and expectorate.

48. What should you do after decannulation?
You must assess respiratory status and oxygen saturation, apply an alternative method of oxygen delivery, and instruct the patient to splint the stoma when coughing, swallowing, or speaking.

49. The primary purpose of the cuff in a tracheostomy tube is to?
The primary purpose of the cuff is to hold the tube in place during specific treatments and prevent aspiration by creating a seal in the trachea.

50. What is a single cannula tracheostomy tube referred to as?
A single cannula tracheostomy tube is referred to as a cuffed tracheostomy tube.

51. To promote safety and comfort for a patient with an endotracheal tube, what should you assess?
You should assess the placement of the tube to ensure proper ventilation and prevent complications.

52. How often should a patient with an endotracheal tube be repositioned to promote maximum ventilation and lung expansion?
A patient with an endotracheal tube should be repositioned every two hours.

53. What should you monitor while suctioning a patient?
You should monitor the patient’s pulse oximetry to assess oxygen levels and ensure safety.

54. What is the first action before suctioning a patient?
The first action is to wash hands to prevent infection.

55. Why is it important to clean the inner cannula of a tracheostomy tube?
Cleaning the inner cannula helps remove secretions and maintain a patent airway.

56. Intermittent suctioning should not exceed how many seconds?
Intermittent suctioning should not exceed 10 seconds.

57. What device is commonly used to begin speech therapy in tracheostomy patients?
A speaking cap, often referred to as a Passy-Muir valve, is used to facilitate speech in tracheostomy patients.

58. What signs and symptoms should you assess at the tracheostomy stoma site?
You should assess for blood or purulent drainage around the stoma, indicating infection or trauma.

59. What is a common complication of suctioning a patient with a tracheostomy?
Suctioning can cause hypoxia if not performed correctly.

60. What is the recommended catheter length for suctioning an adult patient?
The recommended catheter length is 5-6 inches for safe and effective suctioning.

61. When caring for a patient with a tracheostomy tube, what equipment must be kept at the bedside?
A sterile hemostat and an extra sterile tracheostomy set should always be kept at the bedside.

62. What should you do before suctioning a patient with a tracheostomy tube?
You should provide extra oxygen to prevent hypoxia during the procedure.

63. A patient with throat cancer is 4 days post-operative and has a tracheostomy. Which part of the tracheostomy tube is removed for cleaning?
The inner cannula is removed for cleaning to maintain a clear airway.

64. What part of a tracheostomy tube should be cleaned regularly?
The inner cannula should be cleaned to prevent obstruction and maintain patency.

65. What is the most common catheter size recommended for tracheal suctioning in adults?
The recommended size is 12 to 16 French for adult patients.

66. What is the priority responsibility for a patient with a tracheostomy?
The priority is to maintain a patent airway.

67. What should you do if a tracheostomy tube is accidentally dislodged 2 days post-procedure?
You should immediately obtain an obturator and a spare tracheostomy tube from the head of the bed and reinsert the tube if possible.

68. What intervention helps prevent hypoxia during suctioning?
Hyperoxygenate the patient as ordered by the physician before and after suctioning.

69. What is a difference between a tracheostomy tube and a trans-tracheal catheter?
A trans-tracheal catheter delivers oxygen throughout the respiratory cycle and allows the patient to speak.

70. What is the appropriate care of the suction catheter following its use?
The catheter must be discarded after each use to prevent cross-contamination.

71. Which position is recommended when suctioning an unconscious patient?
The side-lying position is recommended to prevent aspiration.

72. Which position is recommended when suctioning an alert and conscious patient?
The semi-Fowler’s position is ideal for a conscious patient.

73. What cleansing solution is appropriate for the inner cannula of a tracheostomy tube?
Hydrogen peroxide is the recommended cleansing solution.

74. What equipment should be available in a patient’s room after a new tracheostomy?
A pulse oximeter, spare tracheostomy set, suction catheter kit, and an Ambu bag should be readily available.

75. What is the most appropriate action for a patient with a 2-day-old tracheostomy?
You should clean the tracheostomy tube at least once per shift to maintain patency.

76. What is an appropriate diagnosis for a patient requiring tracheal suctioning?
The appropriate diagnosis is ineffective airway clearance.

77. What is the recommended wall suction setting for an adult patient?
The recommended setting is 110-150 mm Hg.

78. What interventions minimize the risk of infection for a patient with a tracheostomy?
Changing respiratory equipment every 8 hours, draining water that condenses in tubing, and providing frequent oral care help reduce infection risk.

79. Why should the suction catheter remain in its wrapper and attached to the suction machine before use?
To maintain sterility and reduce the risk of contamination.

80. What are appropriate and safe actions for suctioning a patient through a tracheostomy tube?
Moisten the catheter tip in sterile saline before suctioning, pre-oxygenate the patient, introduce the catheter using a sterile gloved hand, and assess the lungs before the procedure.

81. How should you safely change the neck ties on a tracheostomy tube?
You should have a second healthcare team member assist to prevent accidental dislodgement.

82. What equipment should always be kept at the bedside of a tracheostomy patient?
A sterile packaged hemostat and an extra sterile tracheostomy set should be at the bedside for emergencies.

83. What should be assessed before suctioning a patient’s tracheostomy?
Exudate, edema, and respiratory obstruction should be assessed before suctioning.

84. What is the recommended patient position for suctioning a tracheostomy?
The patient should be in a semi-Fowler’s position.

85. What percent of oxygen should be used to pre-oxygenate a patient before suctioning?
100% oxygen should be used for pre-oxygenation.

86. How long should you suction a tracheostomy tube?
Suctioning should not exceed 10 seconds.

87. What should be done after suctioning a tracheostomy?
Auscultate lung sounds to evaluate the effectiveness of the procedure.

88. What is the recommended position for performing tracheostomy care?
The semi-Fowler’s position is recommended for patient safety and comfort.

89. What part of a tracheostomy tube should never be removed during care?
The outer cannula should never be removed.

90. Which intervention reduces the risk for skin breakdown in a patient with a new tracheostomy?
Cleaning and assessing the skin around the stoma frequently will reduce the risk of skin breakdown.

91. Which technique should you use to change a patient’s tracheostomy ties?
You should ensure that two fingers fit snugly under the tie to prevent constriction and ensure patient comfort.

92. What is the function of the emergency tracheostomy equipment bag?
The emergency tracheostomy equipment bag is used to provide equipment for changing or reinserting a tracheostomy tube in an emergency.

93. How often should tracheostomy dressings be changed?
Tracheostomy dressings should be changed every 8 hours (Q8H) and as needed (PRN) to maintain cleanliness and prevent infection.

94. Why are tracheostomy tubes preferred over endotracheal tubes for long-term ventilation?
Tracheostomy tubes are preferred because endotracheal tubes impede oral hygiene, are not well tolerated by awake patients, and can cause pressure sores and mucosal damage to the lips and mouth.

95. What is the function of an obturator in a tracheostomy tube?
The obturator provides a smooth tip for easier insertion into the trachea, making placement of the tracheostomy tube safer.

96. How should hydrogen peroxide be used for tracheostomy dressing changes?
Hydrogen peroxide should be diluted half-strength with sterile saline before using it for dressing changes.

97. Which of the following is NOT an appropriate action when a tracheostomy tube is blocked?
Inserting a plug and encouraging coughing is not an appropriate action for a blocked tracheostomy tube.

98. Which of the following is NOT a sign of stomal infection?
Subcutaneous emphysema is not considered a sign of stomal infection. Typical signs include redness, thick mucosal discharge, and crusting around the stoma.

99. Which patient does NOT have an indication for a tracheostomy?
A post-op hernia repair patient who is expected to be on a ventilator for 5 days does not have an indication for a tracheostomy.

100. How can you best minimize a patient’s risk for infection during tracheostomy care?
You should adhere to sterile technique when appropriate, as this is the most important factor in minimizing infection risk.

Final Thoughts

A tracheostomy is a vital medical procedure that plays a critical role in managing airway obstructions, facilitating ventilation, and improving the quality of life for patients with severe respiratory issues.

Understanding the indications, techniques, and care associated with tracheostomies is essential for healthcare providers to ensure optimal patient outcomes and minimize potential complications.