Mobilization of Secretions
One of the most important aspects of care for any
patient with a tracheostomy is mobilization of secretions.
Mobilization consists of 3 primary factors: adequate
hydration, physical mobility, and removal of secretions.
Adequate hydration is necessary to keep secretions
thin and mobile. Humidified tracheostomy collars provide
some moisture but are not a source of hydration. An
open tracheostomy usually requires added humidity to
provide comfort and prevent drying of mucous membranes
and thickening of secretions. For hospitalized
patients, humidity can be provided by using a heat and
moisture exchanger, a T-piece, or a tracheostomy mask.23
A capped tracheostomy tube restores the natural moisture
of the upper part of the airway.
Deconditioning is a common problem in ICU patients
with a tracheostomy and can be prevented with regular
physical mobility.29 A program of progressive mobility,
combined with range-of-motion exercises, especially of
the upper extremities, will also help mobilize secretions.
25 Having the patient sit in a chair helps maintain a
position of function; the diaphragm is used more effectively,
allowing a more effective cough.
Removal of secretions can be achieved by suctioning
and allowing the patient to cough. Suctioning should be
an integral part of the assessment of tracheostomy patients.
Easy passage of the suction catheter and return of tracheal
secretions confirms proper placement of the tracheostomy