NURSING CARE: BASIC PRINCIPLES OF TRACHEOSTOMY CARE AT HOME.

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ISSN 2320-5407 International Journal of Advanced Research (2016), Volume 4, Issue 6, 494-497
494
Journal homepage:http://www.journalijar.com INTERNATIONAL JOURNAL
Journal DOI:10.21474/IJAR01 OF ADVANCED RESEARCH
RESEARCH ARTICLE
NURSING CARE: BASIC PRINCIPLES OF TRACHEOSTOMY CARE AT HOME.
Türkan KARACA, RN, PhD.
Assistant Proffesor, Affiliation: Adıyaman University, Nursing School.
Manuscript Info Abstract
Manuscript History:
Received: 12 April 2016
Final Accepted: 19 May 2016
Published Online: June 2016
Key words:Tracheostomy,
Home Care, Nursing
*Corresponding Author
Türkan KARACA.
In recent years, the number of patients with tracheostomy is increasing
internationally. Tracheotomy is defined as a surgical operation that allows
airway patency by creating an opening in alignment of the front wall of
trachea on the 3rd or 4th cartilaginous ring; and it is known to be one of the
earliest lifesaving methods. Changes in health care and economic pressures
have led to shorter stays in acute care facilities, and as the number of
tracheostomies being performed in ENT and ICU are increasing, more
tracheostomized patients are being discharged home. For a patient to be
discharged home with tracheostomy patients should be independent with
their care needs. It is essential for the nurses to consider the individual's
ability in light of this and prevent complications on long-term tracheostomy.
The process of patient home care after discharge hospital includes preventing
infection, suctioning, humidification, nutrition, tube cleaning, tube changing,
stoma care and tracheostomy ties changing.
Copy Right, IJAR, 2016,. All rights reserved.
Introduction:-
In recent years, the number of patients with tracheostomy is increasing internationally (Docherty 2001, Baskin et al.
2004; Lewis & Oliver 2005; Parker et al. 2007). The concept of tracheotomy is originated from Greek, and it means
“cutting the trachea”. Tracheotomy is defined as a surgical operation that allows airway patency by creating an
opening in alignment of the front wall of trachea on the 3rd or 4th cartilaginous ring; and it is known to be one of the
earliest lifesaving methods (Hickey, 2002). Tracheotomy is usually temporary, and this opening can be closed when
the patient is capable of functioning normal respiration. As for tracheostomy the patient usually meets the air need
from this opening and lives withtracheostomy in the rest of his/her life after discharge hospital (Hickey, 2002;
Russel and Matta, 2004).
Changes in health care and economic pressures have led to shorter stays in acute care facilities (Lewarski, 2005;
National Institute for Health Research, 2009) and as the number of tracheostomies being performed in ENT and
ICU are increasing, more tracheostomized patients are being discharged home (Garner et al., 2007). For a patient to
be discharged home with tracheostomy patients should be independent with their care needs (Bowers and Scase,
2007). It is essential for the nurses to consider the individual'sability in light of this and prevent complications on
long-term tracheostomy.
The process of patient home care after discharge hospital includes preventing infection, suctioning, humidification,
nutrition, tube cleaning, tube changing, stoma care and tracheostomy ties changing (Tamburri 2000; Serra 2000;
Norwood et al. 2004; Lewis & Oliver 2005; Freeman 2011).

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Tracheostomy Care at Home:
Preventing infection:
The mouth and nose act as natural barriers against bacteria and infection. The person with a tracheostomy does not
have the same protection from infection as those who breathe through their mouth and nose. Because it is a more
direct pathway, the stoma makes it easier for bacteria to get into the trachea (www.nmh.org).The patient with a
tracheostomy is at risk for infection of the pulmonary tree. Bronchopulmonary infections occur, because the
tracheostomy bypasses the protective upper airway mechanisms, e.g., filtering, warming, and humidifying the
inhaled air. Retained secretions due to decreased mucociliary action and an ineffective or absent cough reflex
provide an excellent medium for bacterial growth. Careful suctioning reduces mucosal trauma, which may lead to
tracheal infection, and prevents the introduction of bacteria into the trachea(www.smiths-medical.com).
The most important thing to prevent infection is cleaning hands before and after doing anything to the tracheostomy
area or tube. The other tips for prevention infection are(TracheostomyGoingHome.doc):
 Never reuse clear plastic catheters.
 Always perform routine tracheostomy care.
 Keep the tracheostomy area clean and dry.
 Keep tracheostomy tubes and suction equipment clean and dry.
 No smoking in the house.
 Clean equipment regularly.
 Replace disposable equipment on a regular schedule.
 Avoid people, including friends and family that have colds or the flu. If they must be near you they should wear
a mask.
Suctioning:
The body's natural defencemechanism in the respiratory tract is the mucocilliaryescalator: inhaled foreign matter,
bacteria and debris are transported in the mucus by cilia upwards to throat. Suctioning the airway using sterile
technique is essential to remove secretions and maintain a clear airway (Tamburri, 2000; Feber 2006). It is
imperative that both patient and family recognize the indications for suctioning(Serra, 2000; Dixon, 2003; Karuga
and ark, 2012; Dawson, 2014):
 Noisy or moist-sounding respirations
 Increased pulse rate
 Increased or labored respirations
 Nonproductive coughing
 Crackles or wheezes
 Patient requests suctioning
 Tube changes
The tips suctioning are (TracheostomyGoingHome.doc):
 Thecathetershould not be in theairwayformorethan 10 to 15 seconds.
 Do not applysuctionwheninsertingthecatheter. Onlyapplysuctionwhenwithdrawingthecatheter.
 Thesamecathetermay be usedduringeachsuctionattemptduringthesamesuctionsession as long as it has not
touchedanything, otherthanthetracheostomytube.
 Ifthe inside of thecatheterbecomesplugged, throw it out. Replacewithanothersterilecatheter.
 Do not dip thecatheterintoanytype of waterto test thesuctionortoclearthecatheterbetweensuctionattempts.
 Whensuctioning is completethrowoutthecatheter.
 Some individuals may have to be manually ventilated (bagged) before and after suctioning. This may help move
secretions higher in the airway. This may also help with breathing.
 Reconnect trach mask, trach swivel, cork/speaking valve, ventilator and/or the heat and moisture exchanger
when needed.
 May use alcohol based hand rub for cleaning hands before and after suctioning if soap and water not available.
Humidification:
The breathing air goes through the nose and mouth, where it is warmed and humidified. A tracheostomy tube
bypasses the nose and mouth. This can result in thick, dried secretions and a blocked tube (www.nmh.org). Due to
this reason, adequate humidification of the trachea is very important. The importance of humidification in reducing

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the thickness of secretions and build-up of crusty formations is discussed with the patient (Minsley and Wrenn,
1996). Symptoms of insufficient humidity include (Roberts, 1995;Karuga and ark, 2012; Dawson, 2014):
 increased, unproductive coughing
 a change of mucus from thin to a thick, sticky consistency and from clear to pale yellow
 shortness of breath from a mucous-plug obstruction
 blood-streaked mucous
 noisy, labored respirations
For patients who are very young or bedridden, a tracheostomy collar with a warm humidification system is effective
(Fitton, 1994). In other situations, the use of a room humidifier or vaporizer may be useful (Craven and Hirnle,
1996). Adequate fluid intake (2000- 2500 ml/day) will help moisten the tracheal tissues and thin secretions
(www.nmh.org).
Nutrition:
The patient should be evaluated for nutritional well-being and wound healing. The nurse stresses the relationship
between good nutrition, meticulous skin care, and the prevention of wound infection (Minsley and Wrenn,
1996).The patient with a tracheostomy is at risk of nutritional deficiency, because of altered anatomy and less taste
and smell sensations (Dixon, 2003). Maintenance of weight is one objective measure of nutritional adequacy.
Tube Cleaning:
It is very important to keep the inner cannula of the tracheostomy tube clean and free from dried secretions. Dried
secretions can occlude the trach tube and make it difficult for the patient to breathe (Breath of Life, 2009). The inner
cannula should be cleaned 2 or 3 times a day. It is best to clean it when doing the dressing change. (www.nmh.org).
Tube Changing:
Theentiretracheostomytubeshould be routinelychangedevery 6 to 8 weeks(Minsley and Wrenn,
1996).Italsowillneedto be changedifthecuff is torn, the pilot ballooncut, orthere is difficulty in passing a
suctioncatheter.The purpose of changing the tracheostomy tube is to minimize infection and granulation tissue
formation(Minsley and Wrenn, 1996). In most cases, patients can change the tracheostomy tube at home, once they
are proficient and confident in their ability (Dixon, 2003). It is very important to use sterile technique during the
tracheostomy change procedure.
Stoma Care:
The stoma is the opening through the skin. Taking care of the skin around the tracheostomy is one of the most
important parts of the care you will have to provide at home. It is important to keep the stoma as clean and dry as
possible. Clean the stoma area and apply a new dressing 2 to 3 times a dayor more often if needed. (www.nmh.org).
It is important to clean stoma preventing infection. It is best to do the stoma care in the morning and before going to
bed.
The patient and family are instructed to change tracheostomy dressings that are soiled or moist. These dressings can
harbor bacteria, which contribute to skin breakdown and infection at the tracheal stoma. Careful daily assessment of
the stoma for the cardinal signs of infection, such as redness, drainage, swelling, and pain, will alert the patient to
early signs of infection and prompt treatment. (www.smiths-medical.com)
Tracheostomy Ties Changing:
The patient's neck is another common site of skin breakdown and potential infection, as related to the tracheostomy-
securing device most often, twill ties. Tissue damage occurs under the ties, which act as a constricting band that puts
greater pressure on neck tissues (Craven and Hirnle, 1996). An alternative to traditional twill ties is the Velcro type
holder, which secures the tracheostomy tube. Because of its design, wide neck band and elastic portion to allow for
movement or cough, this device helps to prevent skin breakdown by reducing the amount of pressure on neck tissues
(Breath of Life, 2009; www.nmh.org). When retying the ties, do not pull them too tight, as you may decrease
theblood flow to the patient’s head and cause too much pressure to the skinof the neck.

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Conclusion:
Caring for a patient with a tracheostomy in the home setting requires both patient and family to acquire many new
skills. The nurse helps them integrate these new skills into their daily lives. In this way, the patient and family learn
the necessary skills and achieve a level of confidence that eases the transition to home care.
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