A tracheostomy is an artificial airway created through a surgical intervention to allow the patient with compromised airways to breathe and manage secretions through the neck instead of the mouth and nose. The procedure can be done as an emergency or elective procedure, depending on the patient's condition and indication for surgery. In an emergency situation, the procedure is often done to relieve airway obstruction due to trauma, infection, or other conditions. On the other hand, in elective tracheostomy, the procedure is performed to facilitate long-term ventilatory support in patients with chronic respiratory failure or those who need prolonged intubation. During tracheostomy an opening (stoma) is created in front of the neck and into the trachea or windpipe. This surgical intervention can be performed for both diagnostic and therapeutic purposes. Tracheostomy is an invasive procedure that requires careful assessment of the patient's airway and meticulous surgical technique to avoid potential complications such as bleeding, infection, or injury to nearby structures. Therefore, tracheostomy care nursing and tracheostomy tube care are critical in preventing and managing potential complications. Tracheostomy suctioning steps should also be followed to maintain airway patency and manage secretions effectively. It is also important to consider stoma tracheostomy care and tracheostomy care at home to ensure proper healing and prevent infection.

Tracheostomy is a procedure that is often recommended for patients who have significant airway compromise or require long-term mechanical ventilation. The decision to perform a tracheostomy can be a complex one as it involves careful evaluation of the patient's medical history, current clinical status, and prognosis. Following are the indications for tracheostomy and the patient who may benefit from this procedure;

Indications for Tracheostomy-

• Upper airway obstruction: Tracheostomy may be recommended in patients with upper airway obstruction due to tumors, inflammation, or trauma that causes difficulty breathing or swallowing.
• Prolonged mechanical ventilation: Patients who require long-term mechanical ventilation, typically greater than 14 days, may benefit from a tracheostomy to facilitate weaning from the ventilator and improve patient comfort and mobility.
• Respiratory failure: Tracheostomy may be necessary for patients who suffer from chronic respiratory failure, such as individuals with COPD or neuromuscular disease, to help manage their airway and improve their overall quality of life.

Pulmonary toilet: Tracheostomy may be performed in patients who require frequent suctioning or airway clearance due to excessive secretions.

Who needs Tracheostomy-

• Critical care patients: Patients who are critically ill and require intensive care may need a tracheostomy for airway management and mechanical ventilation.
• Oncology patients: Tracheostomy may be performed in patients with head and neck cancers that cause airway obstruction.
• Neurological patients: Tracheostomy may be needed for patients with neuromuscular disorders like ALS or muscular dystrophy, who may have difficulty breathing due to weak muscles and require additional respiratory support to improve their quality of life.
• Trauma patients: Patients with severe traumatic injuries to the head, neck, or chest may require emergency tracheostomy to relieve airway obstruction.

Tracheostomy tube care is a crucial aspect of managing patients with a tracheostomy. Proper care of the tracheostomy tube helps prevent infection, maintain patency, and promote healing of the stoma. Follow these steps for a better tracheostomy tube care;

• Hand hygiene: Before performing any tracheostomy tube care, it is essential to perform hand hygiene using soap and water or alcohol-based hand sanitizer.
• Site care: Clean the stoma site with sterile saline and gauze or sterile cotton swabs at least twice a day to remove any debris, crusts, or secretions that may accumulate. Apply a sterile dressing to the stoma site to absorb any exudate and protect the skin from irritation.
• Tube care: Clean the outer surface of the tracheostomy tube with sterile saline and gauze or cotton swabs. Replace the inner cannula with a new one if it becomes soiled or if there is difficulty in suctioning secretions. Always ensure that the tracheostomy tube is secure and properly placed to avoid accidental dislodgement.
• Humidification: Provide adequate humidification to the patient by using a heated humidifier or a sterile water solution to maintain a moist environment in the tracheostomy tube and prevent drying of secretions.
• Communication: Patients with a tracheostomy may have difficulty speaking. Encourage patients to communicate using alternative methods such as writing, gestures, or assistive devices.

A blocked tracheostomy can be a life-threatening emergency. Patients with a tracheostomy and their caregivers should be aware of the signs and symptoms of a blocked tracheostomy to seek prompt medical attention. Below are the common signs and symptoms of a blocked tracheostomy;
Signs and Symptoms of Blocked Tracheostomy
Difficulty breathing: A blocked tracheostomy can cause difficulty breathing, shortness of breath, or even suffocation. Patients may have increased work of breathing, wheezing, or stridor.
Inability to suction secretions: A blocked tracheostomy may prevent the effective suctioning of secretions, leading to an accumulation of mucus or secretions in the airway.
Change in color: Patients with a blocked tracheostomy may develop a bluish discoloration of the skin, lips, or nails due to decreased oxygenation.
Coughing or choking: Patients may experience coughing or choking, particularly during meals or when drinking fluids.
Increased heart rate: A blocked tracheostomy can cause an increased heart rate due to the decreased oxygen supply to the body.
Altered mental status: In severe cases, a blocked tracheostomy can cause confusion, drowsiness, or loss of consciousness due to hypoxia.

Proper tracheostomy care is critical to prevent complications such as infection, tracheal stenosis, or decannulation. Maintaining hygiene of the tracheostomy site, changing the tracheostomy tube as needed, and regular tracheostomy care and suctioning can prevent the accumulation of secretions and other debris that may cause blockages. Appropriate care can also prevent the need for additional interventions, such as emergency tracheostomy tube changes or hospital readmissions. Thus, trach care is important for maintaining the patient's overall respiratory health and avoiding potential complications.

HCAH has been providing unparalleled healthcare services to patients in the comfort of their homes. Our dedicated team of experienced nurses understands the challenges involved in taking care of patients with a tracheostomy. We offer specialized tracheostomy care nursing services, including tracheostomy tube care, tracheostomy suctioning steps, and tracheostomy care and suctioning, ensuring that our patients receive the best care possible. Trust us to provide exceptional care to you or your loved one with a tracheostomy, right in the comfort of your own home.