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Nurse for Tracheostomy Care at Home

Specialist at Home

Tracheostomy Care at Home

A tracheotomy is an operation in which a small opening is made in the windpipe (trachea) through a cut made in the skin on the neck. After the skin has healed, the opening is called a stoma or tracheostomy. A tracheostomy tube is kept in the stoma to keep the hole open. Sometimes people refer to the tracheostomy simply as the "trach".

Two different kinds of tracheostomy tubes are used for patients:

  1. Single cannula trach tubes which are used primarily for children, and
  2. Dual cannula trach tubes which contain an inner cannula for cleaning.

Trach tubes come in a variety of materials: plastic (PVC), silicone and metal. The operating physician will determine which material is best suited for a patient based on the length required, as well as any anatomical challenges to maintain the airway.

A tracheostomy is usually done for one of three reasons:

  1. to bypass an obstructed upper airway;
  2. to clean and remove secretions from the airway; and
  3. to more easily, and more safely, deliver oxygen to the lungs.

All tracheostomies are performed because of lack of air reaching the lungs. There are many reasons why sufficient air cannot get to the lungs.

Airway problems that may require a tracheostomy

  • Tumors, such as Cystic Hygroma
  • Laryngectomy
  • Infection, such as epiglottitis or croup
  • Subglottic stenosis
  • Subglottic web
  • Tracheomalacia
  • Vocal Cord Paralysis (VCP)
  • Laryngeal injury or spasms
  • Congenital abnormalities of the airway
  • Large tongue or small jaw that blocks airway
  • Treacher Collins and Pierre Robin Syndromes
  • Severe neck or mouth injuries
  • Airway burns from inhalation of corrosive material, smoke or steam
  • Obstructive sleep apnea
  • Foreign body obstruction

Lung problems that may require a tracheostomy

  • Need for prolonged respiratory support, such as Bronchopulmonary Dysplasia (BPD)
  • Chronic pulmonary disease to reduce anatomic dead space
  • Chest wall injury
  • Diaphragm dysfunction

Other reasons for a tracheostomy

  • Neuromuscular diseases paralyzing or weakening chest muscles and diaphragm
  • Aspiration related to muscle or sensory problems in the throat
  • Fracture of cervical vertebrae with spinal cord injury
  • Long-term unconsciousness or coma
  • Disorders of respiratory control such as congenital central hypoventilation or central apnea
  • Facial surgery and facial burns
  • Anaphylaxis (severe allergic reaction)

Acute airway obstruction can occur in patients who have undergone tracheostomy or laryngectomy often due to mucous plugging or tube displacement. The level of confidence in managing tracheostomy emergencies depends on the level of critical care experience and previous learning in the management of tracheostomy emergencies. At CARE at HOME we ensure that our nurses have adequate ICU experience. We further reinforce it with hands-on experience in hospitals as well as training on high fidelity manikins at our Safercare Simulation Lab, located in house at CIHS. For further details please visit www.safercare.com. The nurses are trained and evaluated on how to perform CPR (CardioPulmonary Resuscitation) and other emergency actions in the event of an emergency.

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