Chapter 10: Tubes and Devices
10.5 Tracheostomies
Critical Thinking Exercises: Questions, Answers, and Sources / References
- When suctioning your patient who has a tracheostomy, you notice thick, tenacious secretions. What interventions should be implemented?
Answer: Hydrate the patient if not contraindicated. Consider adding moisture to the air / oxygen. Physio, mobilization, hydration, suction and medications as appropriate.
Sources:
British Thoracic Society [BTS]. (2014). Standards for the care of adult patients with a temporary Tracheostomy; Standards and Guidelines. Intensive Care Society Standards. https://www.evidence.nhs.uk/search?q=Standards+for+the+care+of+adult+patients+with+a+temporary+tracheostomy.
The Royal Children’s Hospital Melbourne (RCHM). (nd). Tracheostomy Guidelines. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Tracheostomy_Management_Guidelines/#Related Documents
- What methods of communication might you use for your patient with a tracheostomy tube who is unable to speak?
Answer: discuss this with the interdisciplinary team consider if the tracheostomy tube can be changed to allow the patient some speech capabilities ie. Fenestrated tubes have a number of holes in the inner and outer cannula. They allow air to flow from the lungs over the vocal cords. These can only to be used with patients who can swallow without risk of aspiration. They also allow the patient to talk because air can move through the larynx (St.George’s University Hospital, nd).
For some, a permanent tracheostomy has led them to acquire speaking valves (BTS, 2014)
Communication via non verbal means ie. white board / paper and pencil, touch pads, computers
Sources:
St. George’s University Hospital, (nd). Tracheostomy Tubes. https://www.stgeorges.nhs.uk/gps-and-clinicians/clinical-resources/tracheostomy-guidelines/tracheostomy-tubes/
British Thoracic Society [BTS]. (2014). Standards for the care of adult patients with a temporary Tracheostomy; Standards and Guidelines. Intensive Care Society Standards. https://www.evidence.nhs.uk/search?q=Standards+for+the+care+of+adult+patients+with+a+temporary+tracheostomy.
3. Which of the following situation(s) present a concern. Answer yes / no
| situation | if the situation is a concern | More information |
| If a person has a cuffed tracheostomy in place requires manual ventilation, such as with a bag and mask via the nose, will this deliver oxygen to the patient? | No | The cuff on the trach occludes air flow into the trachea. The bag must be attached to the trach in order to allow oxygen delivery. |
| A suction catheter cannot pass through a tracheostomy. | Yes | suggests either the suction catheter is too large (not likely) or the airway is obstructing. |
| A patient with an tracheostomy tube that has a cuff inflated and is able to talk | Yes | Inflated cuffed TTs cause air to bypass the larynx thus making it impossible to talk. The nurse needs to assess the TT…the cuff is likely deflated.
Recheck the trach, this shouldn’t be happening |
| Decannulation occurred 4 days ago. The occlusive dressing has fallen off. The wound is now closed. | No | If the patient is not in respiratory distress the necessary actions include respiratory and wound assessment. Redress the site if needed. The occlusive dressing is used intially after decannulation to force air movement through the upper airway. |
Source: British Thoracic Society [BTS]. (2014). Standards for the care of adult patients with a temporary Tracheostomy; Standards and Guidelines. Intensive Care Society Standards. https://www.evidence.nhs.uk/search?q=Standards+for+the+care+of+adult+patients+with+a+temporary+tracheostomy.
4. If a person has a cuffed tracheostomy in place requires manual ventilation, will a bag and mask via the nose deliver oxygen to the patient?
Answer: No. The cuff on the trach occludes air flow into the trachea. The bag must be attached to the trach in order to allow oxygen delivery
Source: British Thoracic Society [BTS]. (2014). Standards for the care of adult patients with a temporary Tracheostomy; Standards and Guidelines. Intensive Care Society Standards. https://www.evidence.nhs.uk/search?q=Standards+for+the+care+of+adult+patients+with+a+temporary+tracheostomy.