TRACHEOSTOMY TUBE
A tracheostomy is a surgical opening of the tracheal anterior wall through the neck area. This opening is made at the second or third cartilaginous ring level and is kept patent by inserting a TT. Indications for placing a permanent TT are (a) to maintain the airway because the normal mechanism to maintain the airway has been compromised, (b) to facilitate long-term means of ventilatory support for patients with respiratory failure by MV, (c) elective or emergency surgery for tracheostomy placement for head or neck trauma, and (d) to minimize the risk of aspiration from inability to swallow or absence of the laryngeal reflex.2
The type and size of the TTs depend on the patient’s needs, reasons for placement, and the size of the patient’s trachea. Tracheostomy tubes can be disposable or nondisposable. Caring for this patient population is based on managing the airway while maintaining the safety of the patients and preventing complications. Patients with a TT are not able to talk or make any sound because the TT is placed beneath the vocal cords. A speaker valve can be used after passing speech therapy evaluation for any risk of aspiration.2 In acute care setting, most patients with TTs have disposable inner cannulas, which are changed every shift and as needed depending on the secretions. For nondisposable TTs, a tracheostomy kit can be used to clean the inner tube. Tracheostomy care is done by the nurses or RTs depending on the hospital policy, and the tracheostomy site should be assessed regularly.