Oxygen Delivering System III: Tracheostomy and T-piece

A tracheostomy is a surgical procedure that creates an opening (stoma) in the anterior trachea to establish a patient airway. It bypasses upper airway obstructions, simplifies secretion removal, permits long-term mechanical ventilation, and facilitates weaning from mechanical ventilation. The tracheostomy tube inserted through the stoma is shorter and slightly wider than an endotracheal tube.

Tracheostomy enhances oral and bronchial hygiene and improves patient comfort by eliminating the need for a tube in the mouth. It minimizes the risk of long-term vocal cord damage compared to endotracheal intubation. These benefits make tracheostomy advantageous for patients requiring prolonged airway management.

Tracheostomy carries risks including bleeding, collapsed lungs, emphysema, and infection at the stoma site. Patients may experience difficulty with speech and swallowing. Accidental decannulation, where the tube becomes dislodged, is also a potential complication requiring emergency equipment availability and close nursing monitoring.

Nurses must ensure the tube is clean and properly positioned, perform regular suctioning to prevent airway obstruction, and check cuff pressure regularly. They should clean the inner cannula daily to prevent secretion buildup and keep emergency equipment readily available. Monitoring for signs of infection or skin breakdown at the stoma is also essential.

The T-piece is an oxygen delivery system that resembles a tracheostomy collar but includes a T-connector attached to an O2 blender. It provides low-pressure support and high oxygen concentration to intubated patients who do not need mechanical ventilation. It allows better oxygen and humidity delivery than a standard tracheostomy collar and enables inline catheter connection for suctioning.

The T-piece offers good humidity, patient comfort, and relatively accurate oxygen concentration (FiO2). However, it can be heavy with tubing and may pull on the tracheostomy tube, causing potential tissue irritation and damage. Nurses must closely monitor the T-piece connector to prevent disconnection and traction on the tracheostomy tube.

Fenestrated tracheostomy tubes have an opening on the dorsal surface. When the cuff is deflated and the inner cannula is removed, this opening facilitates spontaneous breathing and speech. This design allows patients greater flexibility in communication and breathing while maintaining the benefits of the tracheostomy.