A tracheostomy can be a rather daunting procedure for not only the patient, but also for those who perform it at home, whether they are family members or professional caregivers. Therefore, it is very important that some basic concepts are clearly defined, to ensure that the procedure is carried out smoothly without harming the patient's health. We will see how to manage and cope with the post-operative period, but also how and why this type of intervention takes place starting from the first step that follows.
Steps
Part 1 of 5: Aspirate the tracheostomy tube
Step 1. Gather the necessary tools
Aspiration of the tracheostomy tube is important because it helps to keep the airway free from secretion, thus allowing the patient to breathe. Lack of sufficient suction is a major cause of infection in people who have a tracheostomy tube. Here's what you need:
- A suction machine
- Suction tubes (sizes 14 and 16 are those used by adults)
- Sterile latex gloves
- Normal saline solution
- Normal saline solution for the destruction of germs and bacteria ready-made or prepared in a 5 ml syringe
- Clean bowl filled with tap water
Step 2. If you prefer, use a homemade saline solution
The saline solution is introduced into the tracheostomy tube to promote moisture in the tracheobronchial tree and to stimulate cough. Moisture helps loosen secretions so they can be sucked in, while coughing is important in getting the mucus sucked out. For patients who are cared for at home and have a tracheostomy tube, normal saline can also be prepared at home. Here's how to do it:
- Boil 23-24 cl of water for five minutes
- Add 1 teaspoon (5 g) of iodized table salt to the boiling water
- Mix the solution thoroughly
- Store the solution in a clean environment, inside a covered container
- Give it time to cool completely before using it
- Change the solution every day
Step 3. Wash your hands
Caregivers should wash their hands before and after treatment to protect themselves and protect them from infection. To wash your hands properly:
- Soap them with warm water with an antibacterial soap, rubbing them; be sure to do this over the entire surface of your hand, for about 10-20 seconds.
- Rinse with warm water
- Dry your hands with a paper towel or clean cloth
- Close the tap using a paper towel or cloth, to avoid contaminating your hand with the surface of the tap again.
Step 4. Prepare and test the tube
The suction packet must be opened carefully, taking care not to touch the tip of the tube. The ventilation control valve located at the end of the tube can be touched. It connects to the hose on the suction machine.
The suction machine turns on and tests itself through the tip of the tube that allows suction. Test the suction by placing and releasing the thumb at the entrance to the tube
Step 5. Prepare the patient by administering the saline solution
Make sure your shoulders and head are raised slightly so that he feels comfortable during the operation. Ask him to take about 3-4 deep breaths.
- Once the patient has been positioned, put 3-5ml of saline into the cannula. It will help stimulate cough and promote the right humidity. Physiological solution is used regularly during aspiration to avoid the formation of thick and abundant mucus obstructions.
- The number of times normal saline should be introduced varies from person to person depending on the thickness of the secretions.
- The caregiver must observe the color, smell and thickness of the secretions, because they will feel it in case of infections.
Step 6. Place the tube
The tube will be inserted smoothly into the tracheostomy tube, until the patient begins to cough or until the tube stops, unable to go further. It should be introduced 10-12 cm deep into the cannula. The natural curve of the tube must follow the curve of the cannula.
The tube must be pulled back just before suctioning, so as not to bother the patient
Step 7. Carry out the aspiration
The suction is carried out by covering the control hole with the thumb, while the tube is pulled with a slow and circular motion. Aspiration should not be carried out any longer than the patient is unable to hold his breath; in fact, it shouldn't last more than ten seconds.
Step 8. Let the patient receive oxygen
Have the patient take 3-4 deep breaths slowly. This indicates how long the tube must be left inside the tracheostomy tube. It is necessary to give oxygen to the patient after performing each aspiration or to give him time to breathe depending on his condition.
With the tube out, draw the tap water through the cannula to free it of secretions. If you are finished, you can resume the operation
Step 9. Repeat the process if necessary
The tube can be used again and the procedure is repeated depending on whether other secretions are present in the patient's airways. Aspiration repeats until the airways are clear of mucus and secretions.
- After aspiration the oxygen level returns to the values prior to the aspiration operation.
- The suction tube and the cannula must be cleaned. See the next section for more details.
Part 2 of 5: Clean the cannula
Step 1. Gather the necessary tools
It is important to keep the various tubes clean and free of mucus and foreign particles. It is recommended to clean them at least twice a day, once in the morning and once in the evening. However, if cleaning is more frequent, it will be better. Here's what you need:
- Sterile saline water / saline solution (can be made at home)
- 50% diluted hydrogen peroxide (½ portion of water mixed with ½ portion of hydrogen peroxide)
- Small, clean bowls
- Small and thin brush
Step 2. Wash your hands
It is essential to wash your hands, so that they are free from germs and dirt. It will help you prevent any infections due to poor hygiene.
The correct procedure for washing hands was covered above. The most important things to remember are to use a mild soap, lather well and rinse with a clean, dry cloth
Step 3. Immerse the cannula
Put the diluted hydrogen peroxide solution in a bowl and the sterile saline water or saline solution in another. Carefully remove the internal cannula, while keeping the plate around the neck, as explained by the doctor or nurse.
Put the cannula in the bowl containing the hydrogen peroxide solution and let it soak completely until the crusts and particles present have softened or removed
Step 4. Cannula cleaning begins
Using a fine brush, clean the inside and outside of the cannula making sure to carefully remove any mucus and any other residue. Be careful not to be too abrupt and avoid using a rough brush, as it could damage the cannula.
After cleaning it satisfactorily, place it in a bowl with sterile saline or saline water for at least 5-10 minutes
Step 5. Place the cannula in the tracheostomy hole
Now carefully insert the cannula back into the tracheostomy hole, while holding the plate on the neck. Rotate the inner tube until it locks into the safety position. You can gently pull the cannula forward to ensure that it is internally locked in place.
With this step you complete the cleaning operations successfully. If you do them, as already mentioned, at least 2 times a day, you can prevent something serious from happening. As they always say in medicine, "prevention is better than cure"
Part 3 of 5: Clean the Stoma
Step 1. Check the stoma
The stoma should be checked after each aspiration, looking for whether the skin is intact or has any signs of infection. If there are any symptoms of infection (or if anything seems objectionable), see a doctor right away.
Step 2. Clean the area with an antiseptic
The area should be cleaned and sterilized with an antiseptic, such as Betadine solution. The stoma should be cleaned by making a circular motion starting at 12:00, going down until 03:00.
- Therefore, the area should be cleaned with a new gauze, dipped in an antiseptic, starting from 12:00 until 9:00.
- For the lower half of the stoma, always using new gauze, clean starting at 3:00, moving until 6:00. Then, clean again from 9:00 until 6:00.
- The operation should be repeated, using clean gauze for each pass and until the stoma is clean.
Step 3. Change the dressing regularly
The dressing around the tracheostomy should be changed at least twice a day. In this way, you will help prevent any infections in the stoma and respiratory system, but also promote skin integrity. A new dressing helps isolate the skin and absorb any secretions that may leak around the stoma.
If the dressing becomes moist, it must be changed immediately, as it feeds the formation of bacteria and can lead to health complications
Part 4 of 5: Managing General Daily Care
Step 1. Cover the cannula when not in use
The reason why doctors and health professionals are so insistent on covering the cannula is that, when it is uncovered, it can favor the entry of foreign bodies into it and into the trachea. These foreign particles can be made up of dust, sand and other pollutants present in the atmosphere. They can cause irritation and even infections, which are absolutely to be avoided.
- The entry of these elements into the cannula leads to an excessive production of mucus in the trachea, which unfortunately risks clogging it, causing breathing difficulties and even infections, which in turn can be fatal, because they directly affect the lungs and, therefore, breathing. Therefore, it is essential to cover the cannula.
- On a windy day, for example, even after covering the cannula and taking precautions, there may still be a chance of dust entering. In this case, it is recommended to clean it every time you return home after a trip.
Step 2. Avoid swimming
Swimming, in particular, can be very dangerous for any tracheostomy patient. In fact, while swimming, the tracheostomy hole is not completely watertight, nor is the cap on the cannula. Consequently, water is very likely to enter directly into the hole or cannula, causing a disease known as "aspiration pneumonia", in which the water will go into the lungs directly from the tracheostomy hole, causing immediate suffocation.
- A potential stopping of breathing can ultimately lead to death rather quickly. In addition, even small amounts of water can stimulate the bacteria that cause infections, complications that are feared to occur due to the ingress of water.
- And while having a bathtub, it uses the cannula lid. The principle is the same.
Step 3. Keep the air you breathe moist
Breathing usually occurs through the nose. However, after a tracheostomy, this function stops, so it is important that the air you breathe is not dry. To do this it is possible:
- Place a wet cloth over the cannula, keeping it moist
- Use a humidifier to help keep the air in your home moist if it is too dry
- Occasionally put a few drops of sterile saline water (saline) into the cannula. This can help soften the thick mucus plugs, so that they can eventually be pushed out by expectoration.
Step 4. Know when you should be worried
Telltale symptoms that should alarm you (see a doctor immediately) include:
- Bleeding from the hole
- Fever
- Redness, swelling around the hole
- Wheezing and coughing (even after cleaning the tube and clearing the airway from mucus plugs)
- He retched
- Convulsions / seizures
-
Chest pain
Any other symptoms of discomfort or anything that may seem unusual should be reported immediately to the nearest doctor, who will be able to guide and treat you if and when needed
Part 5 of 5: Learn about the tracheostomy
Step 1. Know what a tracheostomy is
Before examining this procedure, it is important to know that two long tube-like structures exist from the mouth and down the throat: the esophagus (or "alimentary canal") and the trachea (or "respiratory canal").
- A tracheostomy is a surgical procedure that involves creating an opening in the trachea (externally through the neck) and then allowing a cannula to be inserted into the opening, ultimately acting as a tube for breathing and for removing any secretions or blockages in the airways.
- Usually, it is done under general anesthesia. However, a mild local anesthetic can also be used in critical situations.
Step 2. Understand why it is performed
There are various reasons why a tracheostomy is performed. However, the key point to note is that, whatever the reason, this directly or indirectly relates to the inability to breathe properly. The procedure is done to ensure that breathing occurs through the airways. For instance:
- When a patient is unable to breathe on their own (for example, in severe coma)
- When something is blocking the airways
- Problems with the voice box (larynx), which create breathing problems
- Paralysis of the muscles surrounding the trachea
- Neck tumors that can press against the windpipe
Step 3. Know how long the cannula is needed
In most cases, a tracheostomy is temporary and after normal breathing and general health are restored, the cannula is removed and the opening closed. However, for some patients permanent use is necessary. This, of course, requires even more meticulous care.
Tracheostomy can be quite traumatic for the patient. Not only does it cause discomfort, but it can also inhibit communication, as well as the ability to perform daily activities and experience the pleasures of life. It occurs particularly in patients who have to use it for a long time. Keep this in mind when you need to assist someone, as they may need moral support
Advice
- Always check that the cannula is free of mucus plugs, bringing a replacement if necessary.
- Always wipe mucus with a cloth or tissue after coughing.
- Ultimately, whether independently or with the help of family members or caregivers, cleaning, hygiene and lack of exposure to foreign bodies will ensure that no complications occur.
