Care of tracheostomy in intensive care

Care of a patient with a tracheostomy is carried out in a hospital after the transfer of the patient from the intensive care unit. Most often, the tracheostomy is applied to the air-pathways, if necessary, in the artificial ventilation of the lungs.

Indications for the procedure

The implementation of tracheostomy in the most suitable stationary conditions involves the selection of the optimal method of preparing the trachea and thorough homeostasis. Often, for the operation, use endotracheal anesthesia or topically apply a solution of novocaine.

The need for an operation on the tracheostomy of the respiratory tract occurs:

• In case of prolonged mechanical ventilation of the lungs;
• In the presence of bulbar disorders;
• If there is no possibility to provide free passability of air-conducting paths in another way;
• With low efficiency of the airway toilet;

Technique of tracheostomy

Operation of airway tracheostomy requires the presence of several types of scalpels - for dissection of the outer layers of the skin and the incision of the trachea. Also during the procedure are applied: sliding hooks, skin and muscle expanders, clamps, sterile tampons and napkins.

The patient is placed in position on the back with the head thrown back. The skin on the surface of the trachea is disinfected with alcohol, antiseptics, iodine solution and thoroughly wiped with sterile napkins.

During the procedure, a vertical incision is applied starting from the thyroid cartilage to the upper edge of the sternum. Further, in the horizontal direction, the fascia is dissected, after which, with the help of the aforementioned set of medinstruments, the muscles are expanded and the trachea is released. The trachea is dissected by puncturing the scalpel and removing a small patch of tissue sufficient to accommodate the respiratory tube.

The free edges of the trachea at the cut-off points of the flap are sutured to the skin, which facilitates the replacement of tracheostomy tubes. Despite the rather complicated technique of tracheotomy, the procedure is greatly facilitated by pre-intubating the patient.

Tube selection

Reliable, thorough care of the tracheostomy in the intensive care unit requires the selection of a suitable tube, the choice of which depends on a number of circumstances. At present, metal double tubes with a cuff are widely used. It is also possible to use plastic tubes, the pressure in which is stabilized with the help of special cylinders.

Proper selection of a quality tube provides simple care for the tracheostomy in the intensive care unit without causing unnecessary inconvenience to the patient. When selecting an unsuitable tube, complications often occur in the form of occlusion of the lumen thick, withered mucus. Therefore, her choice should be entrusted to a specialist.

Tracheotomy tube service

In the case of using metal cannulas, it is required to extract the inner tube at least several times a day for cleaning and treatment with antiseptic preparations. However, the outer parts of the cannula are extremely rare, not more than once a week.

The cuff for the tracheotomy should not be constantly inflated. From it, periodically remove excess air and keep it for about 10 minutes, then return it to the place. Before proceeding with the prophylactic removal of the cuff, carefully remove the foreign accumulated contents from the oropharynx.

Features of care for stoma

Periodic care for the tracheostomy is carried out using sterile gauze and cotton swabs. The surrounding tissues are cleaned by semicircular movements in the outward direction. Then the tissues are evaluated for the presence of complications and infectious lesions.

Care of the tracheostomy requires replacement of the fixatives in case of excessive moistening or accumulation of serious contaminants. Carry out the replacement procedure should be in the presence of outside help. One person holds the tube in a stable position, and his assistant replaces the tube holders.

In the first days after the operation, it is advisable to take care of the tracheostomy and peristomal zone at a frequency of 6-8 hours. At the same time, you can regularly replace gauze dressings as needed. Tools, tools and care products should always be at hand.

Tracheostomy care: algorithm

For the first time, the tube is replaced after a few days after the operation. And the procedure should be performed by an experienced specialist, since this time is not enough to form a dense stoma.

The algorithm of the procedure:

• The patient lies on his back and throws back his head;
• Complete clearance of the tracheobronchial aperture is performed;
• To remove sputum in the patient artificially cause cough;
• A flexible catheter is inserted into the tube cavity, after which a tracheostomy cannula is removed;
• The tube is replaced, the conductor is removed;
• The new tube is fixed and fixed in a stable position;

Connection of patients with tracheostomy to the device of artificial ventilation

Often, care for a patient with a tracheostomy requires the connection of the airways to the ventilator. Connect the device through the previously installed cannula in the presence of auxiliary connections.

For the purpose of stable connection of the patient to the ventilator, the standard cannula can be replaced by a specially designed tube or a conventional intubation design with an inflatable cuff. Directly the device itself for artificial ventilation is connected to the end of the tube by standard devices provided for.

Possible complications

Care of the tracheostomy often makes it necessary to fight with certain complications, which can manifest as soon as the operation is completed, and much later, even if the patient is in a stable state.

The most common complication is the occurrence of bleeding, especially if tracheostomy is performed with the help of improvised drugs in an emergency, directly at the patient's bedside. Eliminate profuse pulsating bleeding by compressing the artery with a cuff. However, in order to avoid excessive loss of blood, the patient must be provided with emergency specialist care.

The rules of tracheostomy care require periodic examination of the patient in order to detect a rather serious complication in the form of subcutaneous emphysema. The cause of the latter may be an incorrect installation of the tracheotomy tube.

Another fairly common complication - airway obstruction, can occur spontaneously, in any period of patient rehabilitation. Most often, the cause of the appearance of obstruction symptoms is the formation of a dense cork formed of thick mucus. If tracheotomy was performed using an internal cannula, the problem can be eliminated by cleaning it. Facilitate the patient's condition during obstruction also allows the execution of vacuum aspiration of the conductive pathways.