The Role of Nurses in Tracheostomy Care: Responsibilities and Expectations

Overview of Tracheostomy

A tracheostomy is a procedure performed by a surgeon by making an opening in the neck to insert a breathing tube into a person’s windpipe, which lets air enter the lungs.

This procedure is a lifesaver for patients who face difficulty in breathing due to conditions such as chronic lung disease, lung/throat infections, or after stroke. Proper cleaning and care of the tracheostomy site is highly essential to prevent complications and ensure the patient’s well-being.

Significance of Nursing Care in Tracheostomy

Nurses play a central role in the overall care and management of patients who have undergone tracheostomies. Their responsibilities start from routine medical care to educating the patient, providing emotional support, and managing emergencies. The expertise and training of nursing care is pivotal to helping patients achieve the fastest possible recovery, maintaining their quality of life, and preventing infections.

Understanding Tracheostomy

Types of Tracheostomy Tubes

Different types of tracheostomy tubes are used depending on the patient’s needs:

• Cuffed Tubes: Equipped with an inflatable cuff in order to seal the upper airway, that prevents air from escaping and protects the lungs from secretions. These are typically used for patients who are prescribed with mechanical ventilation.
• Cuffless Tubes: These tubes have been designed for patients who have the ability to breathe on their own without mechanical support but need a tracheostomy tube so that their airway stays open.
• Fenestrated Tubes: These tubes have openings (fenestrations) usually in form of a hole that allows air to flow through the vocal cords and enables them to speak. They are useful for patients who are being gradually taken off the tracheostomy.
• Adjustable Flange Tubes: These tubes are customized to fit patients who have unique anatomical features, providing a secure and comfortable fit to prevent infections.

Each type of tube has a specific purpose and needs particular care and handling, HCAH Rehab nurses are thoroughly trained to provide the best patient care for different types of tubes.

Responsibilities of Nurses in Tracheostomy Care

Initial Care and Assessment

After a tracheostomy is performed, the foremost priority is to examine the trach site and make sure that the tracheostomy tube is securely and correctly positioned. HCAH Rehab Nurses constantly monitor the patient for any signs of complications such as bleeding, infection, or displacement of the tube. They accurately assess the respiratory status of the patient to ensure that the airway remains clear and functional.

Routine Maintenance and Cleaning

Routine care is paramount to prevent infections and ensure the tracheostomy functions properly. Nurses are responsible for cleaning the stoma site, changing the dressing, and maintaining hygiene. This involves:

• Daily Cleaning: Using sterile techniques to clean around the stoma to prevent infection.
• Changing Dressings: Regularly changing the tracheostomy dressings to keep the area dry and clean.
• Inspecting the Tube: Checking the tracheostomy tube for any signs of blockage or wear and ensuring it is securely in place.

Tracheostomy Suctioning

To maintain a clear airway, nurses perform tracheostomy suctioning to remove mucus and secretions from the tracheostomy tube. This process involves inserting a suction catheter into the tube and applying suction to clear the airway. HCAH Rehab Nurses are skilled in this technique and perform it effectively and safely, minimizing discomfort and risk to the patient.

Emergency Management

Nurses must be prepared to handle emergencies that may arise with tracheostomy patients. These emergencies include:

• Tube Displacement: Quickly realizing and responding to situations where the tracheostomy tube becomes dislodged from its position.
• Blockage: Clearing all blockages in the tube that might obstruct the airway.
• Infection: Identifying signs of infection at the stoma site and initiating appropriate interventions.

Through diligent care and proactive assessment, nurses play a vital role in preventing complications and ensuring the safety and well-being of tracheostomy patients.

Patient and Family Education

Teaching Self-Care

One of the critical roles of tracheostomy care nursing is educating the patient’s family on how to manage their tracheostomy care at home. This involves:

• Demonstration of Procedures: Nurses appropriately demonstrate how to clean the tracheostomy site, change dressings, and perform suctioning, ensuring that the patient understand each step.
• Providing Educational Materials: References that include written instructions, diagrams, and videos help the patient’s family remember and correctly perform the procedures at home.
• Encouraging Questions: Creating an open environment where patients feel comfortable asking questions and freely express concerns about their care.

Family Involvement

Family members play a huge role in the care of patients with tracheostomies, especially at home. Nurses have the responsibility of training family members in assisting with tracheostomy care. This includes:

• Hands-On Training: Teaching family members to practice care techniques under the nurses’ supervision until they feel confident.
• Emergency Preparedness: Teaching family members how to handle potential emergencies, such as tube dislodgement or blockages.
• Emotional Support: Providing assistance on how to offer emotional and psychological support to the patient, to ensure a supportive environment at home nursing.

By equipping both patients and their families with the necessary skills and knowledge, nurses ensure that tracheostomy care continues effectively outside the clinical setting if needed, promoting better outcomes and enhancing the patient’s quality of life.

Psychological and Emotional Support

Addressing Patient Concerns

Living with a tracheostomy can be challenging, both physically and emotionally. HCAH Rehab Nurses are trained to play a crucial role in providing psychological support to their patients by:

• Listening and Understanding: Our Nurses take the time to listen to patients’ fears and concerns, acknowledging the emotional impact of their condition.
• Counselling: Our Rehab centers offer counselling services to help our patients cope with anxiety, depression, or other emotional issues related to their condition.
• Encouraging Participation: Involvement of patients in their care plan tend to give them a sense of control and empowerment over their recovery

Enhancing Communication

A tracheostomy can significantly impact a person’s ability to speak, which can be frustrating and isolating for the patient. Nurses can help improve communication through:

• Speech Therapy: Our nurses collaborate with speech therapists to develop strategies that enable patients to communicate more effectively, even using alternative communication methods if necessary.
• Communication Aids: Introducing tools such as writing boards, picture cards, or digital devices facilitate communication with the patient.
• Patience and Encouragement: We encourage patients to express themselves and patiently help them adapt to new communication methods.

By addressing the psychological and emotional needs of tracheostomy patients, nurses help improve their overall well-being and quality of life, ensuring that care is comprehensive and holistic.