Oxygen Delivering System III: Tracheostomy and T-piece

Oxygen delivery is critical in clinical care, especially for patients with respiratory disorders or those undergoing surgical procedures. Various systems, such as tracheostomy and the T-piece, deliver oxygen to the lungs, ensuring adequate arterial oxygenation.

Tracheostomy

A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term mechanical ventilation, and facilitate weaning from mechanical ventilation.

Working mechanism

The tracheostomy tube, inserted through the stoma, is shorter and slightly wider in diameter than an endotracheal (ET) tube. The tube consists of a flange, pilot balloon, balloon inflation port, and cuff. The cuff ensures the patient receives the volume of air delivered by the ventilator and decreases the risk of aspiration.

Some tracheostomy tubes are fenestrated, meaning they have an opening on the dorsal surface. When the cuff is deflated, and the inner cannula is removed, this facilitates spontaneous breathing and speech.

Advantages and disadvantages

Tracheostomy offers numerous benefits. It enhances oral and bronchial hygiene, improves patient comfort by eliminating the need for a tube in the mouth, and minimizes the risk of long-term vocal cord damage. However, it requires surgical intervention, which carries inherent risks of infection at the stoma, and the maintenance and care of a tracheostomy can be complex. Periodic check-ups with a healthcare provider are vital for ensuring proper care and management of a tracheostomy tube. During these appointments, the tracheostomy site should be assessed frequently for signs of infection or skin breakdown. Additionally, cleaning the inner cannula daily and replacing it to prevent the buildup of secretions that can cause blockage is essential. The patient may also experience difficulty with speech and swallowing, and there is a risk of accidental decannulation (when the tube gets dislodged or removed).

Nursing responsibilities

Nurses play a crucial role in tracheostomy care. They must ensure the tube is clean and properly positioned, perform regular suctioning to prevent airway obstruction from secretions, inflate and deflate the cuff as needed, and check cuff pressure regularly. Additionally, nurses should keep emergency equipment readily available in case of tracheostomy complications.

T-Piece

The T-piece is another system used for oxygen delivery, particularly for patients with a tracheostomy.

Working mechanism

The T-piece resembles a tracheostomy collar but includes a T-connector attached to an O₂ blender. It allows for better oxygen and humidity delivery than a tracheostomy collar and enables the connection of an inline catheter for suctioning.

Advantages and disadvantages

The T-piece offers humidity, 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.

Nursing responsibilities

Nurses must closely monitor the T-piece connector as it can disconnect easily. It is essential to regularly check the connector to ensure it does not exert any traction on the tracheostomy tube. Similarly, the patient's oxygen levels should be monitored to ensure they receive the right amount.