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Tracheostomie I: Procedure en Tubes
Een tracheostomie is een chirurgische procedure waarbij een opening in de trachea wordt gecreëerd, meestal op het niveau van de tweede of derde kraakb…
Tracheostomy is a surgical technique that involves the creation of an opening in the trachea to establish a patent airway, bypass an upper airway obstruction, remove secretions, enable long-term mechanical ventilation, and aid in ventilator weaning.
It is generally performed under local or general anesthesia in a sterile environment.
An incision is made on the anterior neck extending to the trachea, and a tracheostomy tube is inserted and secured with a Velcro strip.
Tracheostomy tubes can be cuffed or cuffless and fenestrated or non-fenestrated.
A cuffed tube is used for patients requiring mechanical ventilation, while a cuffless tube is suitable for long-term tracheostomies without mechanical ventilation.
A fenestrated tube has holes in the shaft, enabling breathing and speech.
Next, post-operative care involves cuff inflation, tube placement confirmation, suturing, and applying a sterile dressing.
Lastly, nursing responsibilities include regular tracheostomy site assessment, sterile dressing changes, monitoring cuff inflation pressure, suctioning the tracheostomy tube, and facilitating communication for speech difficulties.
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Q1: What are the main purposes of performing a tracheostomy?
A tracheostomy establishes a patent airway when oral or nasal intubation is not possible, bypasses upper airway obstructions, and simplifies secretion removal. It enables long-term mechanical ventilation, facilitates ventilator weaning, reduces ventilator-dependent days, decreases hospital length of stay, and improves communication for patients with speech difficulties.
Q2: What are the differences between cuffed and cuffless tracheostomy tubes?
Cuffed tubes have an inflated cuff that seals the opening around the tube to prevent air leakage and aspiration, making them essential for patients requiring mechanical ventilation. Cuffless tubes lack this seal and are suitable for long-term tracheostomies without mechanical ventilation, allowing spontaneous breathing without the need for pressurized sealing.
Q3: How do fenestrated tracheostomy tubes differ from non-fenestrated tubes?
Fenestrated tubes have one or more openings in the shaft that allow patients to breathe spontaneously and speak with the tracheostomy tube in place. Non-fenestrated tubes lack these openings and are used when a complete seal is necessary, such as during mechanical ventilation or when airway protection is the primary goal.
Q4: What components make up a tracheostomy tube?
A tracheostomy tube consists of an outer cannula or main shaft, an inner cannula, and an obturator. The outer cannula is the primary tube inserted into the trachea, the inner cannula can be removed for cleaning, and the obturator guides the direction of the outer cannula during placement and must be removed immediately after insertion to keep the airway open.
Q5: What are the key nursing responsibilities for tracheostomy care?
Nursing care includes regular tracheostomy site assessment, performing sterile dressing changes every 12 to 24 hours, measuring cuff inflation pressure with a cuff manometer at least every 8 hours, and suctioning the tracheostomy tube. Nurses must also ensure patency, provide humidified air to keep secretions thin, and maintain emergency preparedness with spare tubes at the bedside.
Q6: What should be done immediately if accidental decannulation occurs?
Call for help immediately and assess the patient's level of consciousness, ability to breathe, and presence of respiratory distress. Keep a spare tracheostomy tube of the same size and one size smaller at the bedside for prompt reinsertion. Have an obturator readily available to guide the new tube safely into place, and remove it immediately after insertion to maintain airway patency.
Q7: How is a tracheostomy procedure performed and secured?
The procedure is performed in a sterile environment under local or general anesthesia. An incision is made on the anterior neck extending to the trachea, typically at the second or third cartilaginous ring level. The tracheostomy tube is inserted through the opening and secured around the patient's neck with twill tapes or a Velcro strip, then sutured with a sterile dressing applied.