Tracheostomy
A surgical airway through the neck into the trachea
Definition
A tracheostomy is a surgical opening created through the front of the neck into the trachea, providing a secure airway. It may be temporary or permanent.
Indications
- Prolonged mechanical ventilation
- Upper airway obstruction
- Neuromuscular disease
- Severe sleep apnea
Nursing Priorities
- Keep obturator and extra trach at bedside for emergency
- Humidified air/oxygen
- Suction as needed (sterile technique, 10 to 15 seconds maximum, pre-oxygenate)
- Inner cannula care every 8 hours or as needed
- Stoma care: clean with normal saline, check for skin breakdown
- Change ties with two people (never leave trach untied)
- Monitor for complications: accidental decannulation, hemorrhage, infection, tracheomalacia
Teaching
Cover stoma before showering/bathing (avoid swimming). Clean stoma daily. MedicAlert bracelet.
NCLEX Relevance
Obturator at bedside, never leave trach untied during changes.