Prevent Airway Obstruction
The central issue that is likely to occur is obstruction of the airway. Because people are not trained to treat the base of their neck as they would their mouth, they pay less attention to keeping the area clear. This can become problematic if clothing or food enters the opening. What's more, patients often have comorbidities. And these frequently prevent them from raising the alarm if something goes wrong.
If the patient is in a hospital setting, monitoring equipment should be set up to make sure that the patient's breathing remains normal. Monitoring respiratory rate and pulse oximetry should do the trick.
But those caring for patients with tracheostomies need to be able to react if something does go wrong. If food or other particles fall into the tubes, there needs to be accessible equipment nearby to suck out any particles. Suction via a tube should solve all but the most severe obstructions.
Use Disposable Tracheostomy Tubes
Disposable inner cannulas, like the Shiley 6 dic, can be especially useful in situations where the tube gets blocked. Sometimes, removing the inner tube can relieve the blockage. And then, if the patient can breathe through the mouth, have the tube permanently removed.
But when the tracheostomy is permanent, the patient will need to have the inner cannula reinserted. It's not pleasant, but disposable varieties tend to be more useful in real life situations.
Most patients that have had a tracheostomies won't be able to converse with you. That's because the stoma is usually located below the vocal chords.
In effect, it means that patients lose the ability to communicate directly. Carers, therefore, need to be able to adapt to their communication needs. Lip-reading is one common strategy that patients use. But there are also other options, such as synthetic vocal chords that can be attached to the stoma.
But perhaps most importantly, the inability to effectively communicate increases anxiety. Carers need to be aware of this anxiety and help patients to manage how they feel.
Watch Out That Tracheostomy Tubes Have Not Been Displaced
Tracheostomy tubes can dry out, causing patients to cough. One of the consequences of this is that the tracheostomy tubes can be dislodged. This can be quite severe, especially if there is any blockage of the airway. If you suspect that the tube has been displaced by coughing, check airflow immediately.
Site last updated: 21. January 2018
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