Tracheotomy is a common procedure for multiple medical indications.1 To provide
safe and competent care, nursing staff must understand the immediate postoperative
and long-term management of tracheostomy patients. Each institution should
have its own standard policies and procedures for caring for these patients. Basic minimal
care usually consists of cleaning or changing the inner cannula, caring for the
stoma, and suctioning at least 3 times a day. Depending on the thickness and quantity of secretions,
more frequent inspection of the inner cannula may be necessary.
Tracheostomy tubes are made from various materials. Mitchell et al2 recommend that a plastic
tracheostomy tube be used for initial placement. Metal tracheostomy tubes are rigid, lack a cuff, and
cannot be attached to a ventilator or a bag-valve mask. For these reasons and the cost of materials and
production, metal tubes are not commonly used in hospitals today.3 Some plastic tracheostomy tubes conform to a patient’s anatomy as the plastic softens at
body temperature, and silicone tracheostomy tubes can
conform to the size and shape of a patient’s trachea.3
In this article, we discuss management in the intensive
care unit (ICU) of patients with a new tracheostomy.
We include indications for tracheostomy, tube placement,
patient care, prevention of complications, and
emergency management.
Tracheotomy is a common procedure for multiple medical indications.1 To providesafe and competent care, nursing staff must understand the immediate postoperativeand long-term management of tracheostomy patients. Each institution shouldhave its own standard policies and procedures for caring for these patients. Basic minimalcare usually consists of cleaning or changing the inner cannula, caring for thestoma, and suctioning at least 3 times a day. Depending on the thickness and quantity of secretions,more frequent inspection of the inner cannula may be necessary.Tracheostomy tubes are made from various materials. Mitchell et al2 recommend that a plastictracheostomy tube be used for initial placement. Metal tracheostomy tubes are rigid, lack a cuff, andcannot be attached to a ventilator or a bag-valve mask. For these reasons and the cost of materials andproduction, metal tubes are not commonly used in hospitals today.3 Some plastic tracheostomy tubes conform to a patient’s anatomy as the plastic softens atbody temperature, and silicone tracheostomy tubes canconform to the size and shape of a patient’s trachea.3In this article, we discuss management in the intensivecare unit (ICU) of patients with a new tracheostomy.We include indications for tracheostomy, tube placement,patient care, prevention of complications, andemergency management.
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