Living with Tracheostomy by Yishun Health

Living with Tracheostomy

Contents 1. What is a Tracheostomy?................................................... 1 2. Securing Tracheostomy Tube to Neck Method 1: Using cotton tie................................................... 2 Method 2: Using velcro tape................................................ 6 3. Caring for the Stoma........................................................... 8 4. Tracheostomy Suctioning (Removal of secretions) a) Suctioning........................................................................ 11 b) Cleaning the Inner Cannula........................................... 14 c) Nebulisation..................................................................... 16 5. Dealing with Emergency Situations.................................. 17 6. Tracheostomy Home Care List.......................................... 19

What is a Tracheostomy?

The tracheostomy tube allows patients to breathe and carry on with their daily life.

A tracheostomy is a surgical procedure to create an opening (hole) through the neck into the trachea (windpipe) to allow direct access into the breathing tube when a person can no longer support their own breathing.

Therefore, it is important for the patient and caregiver to know how to care for the tracheostomy tube and stoma, which will enable the patient to live a quality life ahead.

A temporary or permanent opening will be created on the neck. A plastic tube, which is called a tracheostomy tube will be inserted into the opening. 1

Basic parts of a Tracheostomy Tube 1. Tracheostomy Tube 2. Non-Fenestrated (without opening) inner tube 3. Fenestrated (with opening) inner tube 4. Obturator 1

5. White Cap

Commonly Used Terms Stoma : Opening of the skin Flange : “Wing” of the tracheostomy tube Fenestrated : With “opening” Non-fenestrated : Without “opening”

Securing Tracheostomy Tube to Neck Method 1: Using cotton tie Items to prepare prior to procedure: • Hand soap • Gloves • Cotton tie • Scissors When to change? • Daily • Whenever wet or dirty

Cotton gauze tie

Step 1: Putting in a New Cotton Tie 1. Do not remove the existing cotton tie yet. 2. Wash your hands with soap and water. Wear gloves. 3. Prepare a cotton tie with a length long enough to go around the patient’s neck two times. (Refer to picture on the left)

4. Lie the patient down with the neck slightly tilted backwards by placing a small rolled towel behind the neck. 5. Alternatively, the patient may be in a seated position in bed or a chair. 6. Insert the new tie into the hole on either side of the flange (wing).

7. Tie a single loop knot.

8. Run the remaining tie behind the neck and insert into the other hole on the flange.

9. Run the tie behind the neck again to the starting hole on the flange and tie a dead knot.

10. Allow one finger spacing between the skin and the tie.

Step 2: Removing the Old Cotton Tie 1. Use scissors to cut the old tie. 2. Stabilise the tracheostomy tube using your hand when loosening the knots on the flange.

Step 3: Securing with Double Knot 1. Tie another knot on the new tie to secure the tube properly. 2. Tuck in the excessive length of the tie along the neck to prevent discomfort.

Method 2: Using Velcro Tape Items to prepare prior to changing: •

Hand soap

•

Gloves

•

Velcro tape

It is recommended to get an extra person to assist with the changing of velcro tape. When to change?

•

When Velcro loses its adhesiveness

•

Whenever it is soiled or necessary

Step 1: Putting in a New Velcro Tape 1. Do not remove the existing velcro tape or cotton tie. 2. Insert one end of new velcro tape into either hole on the flange. 3. Fasten to secure. 4. Run the remaining tape around the neck and insert the other end of the tape into the other hole on the flange. 5. Fasten the other end to secure. 6. Always allow one finger spacing between the skin and the tape. Step 2: Removing the Old Velcro Tape 1. Remove the old velcro tape while stabilising the tracheostomy tube. 2. Fasten the velcro again if necessary.

Caring for the Stoma Items to prepare prior to procedure: 1

3 2 5

1. Hand soap

When to clean?

2. Clean latex gloves

•

At least once per day

3. Sterile cotton balls

•

Whenever dressing is dirty

4. Sterile gauze pack 5. Adhesive tape 6. Cotton wool applicators (optional) 7. Sodium chloride 0.9%

Step 1: Removing Old Dressing 1. Wash hands with soap and water. Wear gloves. 2. Gently pull out the old dressing while stabilising the tube with another hand.

Step 2: Cleaning Stoma Site 1. Wet the cotton ball pack and cotton wool applicators with sodium chloride solution. 2. Clean the area around the stoma and the flange with cotton balls. 3. Ensure the skin area is cleaned free of dirty fluid and hardened secretion. 4. Allow skin to air dry or use a clean gauze to dry.

Step 3: Putting a New Dressing 1. Fold gauze into half and insert one underneath each side of the flange. 2. Apply adhesive tape to secure gauze if needed.

Seek medical advice if you notice the following conditions at the stoma site: •

Swelling, increased pain or discomfort

•

Redness or infection (e.g. pus or an unpleasant or foul smell)

•

Abnormal skin or tissue growth

•

Bleeding

Tracheostomy Suctioning (Removal of secretions) a) Suctioning Items to prepare prior to suctioning: 1

3 5

When to conduct suctioning? • Excessive secretions • Difficulty in coughing out secretion • Express difficulty in breathing • Common time for suctioning - Before mealtimes - Before bed time - Waking up from sleep

1. Clean non-sterile gloves 2. Sterile gloves 3. Clean container 4. Cool boiled water 5. Tracheostomy inner cannula 6. Sterile suction tubing 7. Suction unit

Step 1: Preparing for Suctioning 1. Gather all the items and sit patient in upright position. 2. Wearing a pair of nonsterile gloves, change the inner tube to a nonfenestrated (without opening) one. 3. Stabilise the tracheostomy tube with one hand. Turn anti-clockwise to unlock and remove the fenestrated (with opening) inner tube. 4. Replace with a nonfenestrated (without opening) inner tube and turn clockwise to lock.

Step 2: Perform Suctioning 1. Connect the sterile suction tubing to the suction unit. 2. Wear sterile glove on your dominant hand and nonsterile glove on the other hand 3. Hold the suction port end with your non-dominant hand while the dominant hand holds towards the tip of the suction catheter. 4. Insert the tubing until resistance is felt. 5. Pull the suction catheter out by about 1-2cm and apply suction pressure. 6. Gently twirl the catheter while removing the tubing from the tracheostomy tube. 7. Each suction should not exceed 10 seconds.

b) Cleaning the Inner Cannula Items to prepare:

•

Cool boiled water/ sterile water

•

Tracheostomy brush/ cotton wool applicator

•

Sodium bicarbonate powder (dilute 2 ½ teaspoons in 300ml of water)

•

Container for soaking

Step 1: Clean the inner tube under running water. Step 2: Brush the inner and outer surface of the tube using a tracheostomy brush or cotton wool applicator. Step 3: Remove any hardened secretion if necessary. Soak the inner tube in sodium bicarbonate solution for 30-60 mins before brushing the tube. Step 4: Rinse the tube with cool boiled water and store in a clean container. Step 5: Provide oral care accordingly.

c) Nebulisation Nebulisation is a simple procedure to help loosen thick mucus from the tracheostomy using an air compressor. Items to prepare: • Portable air compressor • Trachy mask • 10ml syringe • Sodium chloride 0.9% solution Step 1: Prepare solution in the mist chamber as per prescription by the doctor. Step 2: Connect the trachy mask to air compressor Step 3: Apply trachy mask over tracheostomy and sit patient upright. Step 4: Allow solution to finish and perform suctioning if needed.

Dealing with Emergency Situations One of the most commonly encountered emergency situations is the tracheostomy tube falling out from the stoma. This is known as tube dislodgement. In the first few weeks after surgery, only a trained healthcare provider should put the tube back in. The longer the tube has been in place, the easier it will be to put the tube back in if it falls out. In the case of tube dislodgement, stay calm and take the following steps: 1. Remove the dislodged tube and try to reinsert the tube after cleaning. Do not forcefully insert it if you encounter any difficulty or resistance. 2. Suction to remove secretions if necessary. 3. If you fail to reinsert the tube, administer oxygen via a trachy mask. 4. Cover the stoma with a thin unfolded layer of gauze and lightly secure it with adhesive tape if the patient is not on oxygen at home. 5. Call an ambulance (995) and inform them of the situation. 6. Monitor the patient continuously until help arrives. When in doubt, always seek medical attention in a timely manner.

Commonly Asked Questions Can I shower with a tracheostomy tube? Yes. But you will need to be very careful and to cover the opening of the tube with the palm of your hand to prevent water from getting into your lungs. Can I talk with a tracheostomy tube? If the voice box is not injured, many people are able to talk with a tracheostomy tube that has a “speaking valve” attached to the tube. You may discuss this with your medical team and a referral to a speech therapist can be made for you. Can I eat with a tracheostomy tube? Some people with a tracheostomy tube who are fully awake and alert are able to eat based on their ability and coordination of muscles to swallow. You will likely have a feeding tube in the nose right after having a tracheostomy surgery to support nutrition intake.

Tracheostomy Home Care List Product Description

Material Cod

Quantity

Tracheostomy Care Pck Dale Tracheostomy Tube Holder

0056-04-070-R

Sterile Applicator Stick 2s

0056-19-217-R

Sterile Gauze 7.5 X 7.5 Cm 5s / Pack

0056-13-005-R

Micropore 1 Inch Tape / Pcs

0056-13-020-R

Cotton Balls Sterile 10s / Pack

0056-03-083-R

Kidney Dish Plastic 6 Inch

0056-11-013-R

Normal Saline 0.9% Inj 20ml

0010-52-004-E

Sodium Bicarbonate Powder 100mg/ Bottle

0005-52-004-E

Latex Glove (S) 100s

0056-07-047-R

Latex Glove (M) 100s

0056-07-048-R

Latex Glove (L) 100s

0056-07-049-R

Suction Catheter 10 Ch

0056-19-180-R

Suction Catheter 12 Ch

0056-19-180-R

Suction Catheter 14 Ch

0056-19-180-R

Suction Catheter 16 Ch

0056-19-180-R

Oral Swab Toothette Plus /Stick

0056-20-059-R

Drawsheet Underpad White 10’S

0088-13-001-R

Referred by: Staff Name: _______________

Signature: _______________

To get the items listed above, you can proceed to the ABLE Studio at KTPHTower B Level 1 or scan the QR code for the product catalogue

Notes

Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.

IP.PE.75.1021