Assisting with a tracheostomy—the surgical creation of an opening in the trachea to insert a breathing tube—is a critical nursing responsibility, especially in intensive care or emergency settings.
Purpose
- To bypass upper airway obstruction and trauma.
- To remove tracheobronchial secretions
- To promote long-term use of mechanical ventilation
- To prevent aspiration of oral or gastric secretion in unconscious or paralyzed patient.
- To replace endotracheal tube when long-term mechanical ventilation is required.
Articles
A tracheostomy set containing the following:
- Toothed dissecting forceps (1 No.).
- Curved mosquito forceps (2 Nos.).
- Straight mosquito forceps (2 Nos.).
- Artery forceps (2 Nos.).
- Allis forceps (2 Nos.).
- Needle holder.
- Double hook retractors (2 Nos.).
- Blunt hook.
- Cricoid hook
- Sharp scissors.
- Tracheal dilator.
- Gallipots (2 Nos.).
- Cutting edge suture needle with cotton thread.
- Vaseline gauze
A clean tray containing the following:
- Suction catheter with connection (sterile).
- Hand towel.
- Kidney basin.
- Scalpel blade (sterile).
- Gloves (sterile).
- Mask
- Apron
- Antiseptic solution.
- Local anesthetic (Xylocaine 2%).
- Syringes (sterile).
- Needles (sterile).
- Sandbag
- Spotlight.
- Tracheostomy tube
Procedure
| Nursing Action | Rationale | |
| 1 | Before procedure Explain the procedure to the patient if conscious and get consent from the patient and relatives | Allays anxiety and facilitates patient’s cooperation |
| 2 | Place the patient in supine position with full extension of neck and head. | Promotes visualization of site of insertion for the procedure |
| 3 | During procedure Remove gown and expose neck. | |
| 4 | Keep suction and oxygen ready for use | Facilitates timely use of articles. |
| 5 | Assist in preparing skin and administering local anesthetic. | Reduces risk of infection. Reduces sensation of pain |
| 6 | Assist in and support patient as incision is made and provide suitable tracheostomy tube for insertion. | |
| 7 | Assist in securing tracheostomy tube to neck while tying with tape. | Reduces chance of tube displacement. |
| 8 | Assist while tube is being sutured in place | Reduces chance of tube displacement |
| 9 | Place Vaseline gauze around tube | |
| 10 | After procedure Assist patient to a comfortable position. | |
| 11 | Replace equipment | |
| 12 | Document time, tube size, purpose of tracheostomy and patient’s condition. |
Postprocedural care
- Connect to ventilator (if needed).
- Place the patient in semi-Fowler’s position.
- Check vital signs.
- Administer analgesics and sedatives as per order.
- Watch for complications like bleeding, respiratory failure, and blockage of tracheostomy tube with secretion
- If metal tube is inserted, leave the stilette in a sterile tray at the bedside.
- Keep suction apparatus and suction tube ready at bedside.
Emergency Preparedness
Always keep at bedside:
- Spare tracheostomy tube (same size and one size smaller)
- Obturator
- Suction equipment
- Ambu bag with trach adapter
- Scissors and trach ties
Family & Patient Education
- Teach daily care and suctioning techniques
- Emphasize hand hygiene and infection prevention
- Demonstrate tube change and emergency response
- Provide written instructions and follow-up schedule
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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