Tracheostomy Care Nurses

Care Health Nursing Services provide tracheostomy care staff for clients with new or recent tracheostomy to maintain patency of the tube and minimize the risk for infection (since the inhaled air by the client is no longer filtered by the upper airways). Initially a tracheostomy may need to be suctioned and cleaned as often as every 1 to 2 hours. After the initial inflammatory response subsides, tracheostomy care may only need to be done once or twice a day, depending on the client.

Our Staff Supervision & Monitoring

In determining the level of supervision and monitoring which is required, it is recommended each patient with a tracheostomy is assessed on an individual basis by the treating medical/surgical and nursing team4 taking into consideration the following factors.
1) Age specific alarm limits
2)Clinical state
3)Nature of the airway problem
4)Ability to breathe and maintain their airway in the event of accidental decannulation
5)Ability to clear own secretions
6)Frequency of suction/tracheostomy tube interventions required
7)Ventilation requirements
8)Cognitive ability

Monitoring may include:
1)Heart rate +/- continuous cardiac monitoring
2)Respiratory rate
3)Pulse oximetry continuous/overnight
4)Oxygen requirements
5)Work of breathing
6)Temperature
7)Blood pressure
8)Behaviour - alert, irritable, lethargic  

Suctioning

Suctioning of the tracheostomy tube is necessary to remove mucus, maintain a patent airway, and avoid tracheostomy tube blockages. Indications for suctioning include:
1)Audible or visual signs of secretions in the tube
2)Signs of respiratory distress
3)Suspicion of a blocked or partially blocked tube
4) Inability by the child to clear the tube by coughing out the secretions
5)Vomiting
6) Changes in ventilation pressures (in ventilated children)
7)Request by the child for suction (older children)
8)Tracheal suctioning should be carried out regularly for patients with a tracheostomy tube. However the frequency varies between patients and is based on individual assessment.
9) Tracheal damage may be caused by suctioning. This can be minimised by using the appropriate sized suction catheter and only suctioning within the tracheostomy tube.