Which nursing intervention will reduce the risk for aspiration in a patient with a tracheostomy?
Show
Safety considerations are important when caring for a patient with a temporary tracheostomy. Early detection and resolution of problems in tracheostomy management are important to prevent serious incidents arising. Nurses working outside critical care areas need to be competent and confident in the management or detection of potential problems with tracheostomies. This article summarises the essential care of a patient with a temporary tracheostomy with reference to best practice guidelines, emphasising the importance of prompt intervention and response, if a potential problem is identified. Nursing Standard. 29, 26, 42-49. doi: 10.7748/ns.29.26.42.e9742 Correspondence
Peer review This article has been subject to double blind peer review Received: 05 November 2014 Accepted: 01 December 2014 Want to read more?Already subscribed? Log inORUnlock full access to RCNi Plus todaySave over 50% on your first 3 monthsYour subscription package includes:
Subscribe RCN student member? Try Nursing Standard StudentAlternatively, you can purchase access to this article for the next seven days. Buy now Or Tracheostomy Nursing Care Plans Diagnosis and InterventionsTracheostomy NCLEX Review and Nursing Care Plans A tracheostomy is an opening that is made through the neck and into the trachea. The tracheostomy tube is inserted into the opening for breathing purposes. Uses of a TracheostomyTracheostomy is performed due to several reasons concerning the airway. The following situations may call for a tracheostomy:
Risk of a TracheostomyGenerally, Tracheostomy is safe. However, in some cases, complications happen most of the time while the surgery is ongoing or right after the procedure is done. The risk increases when the procedure is performed in an emergency. Early complications may include the following:
Long-term problems may occur when the tracheostomy tube is longer in place. These complications include:
For long-term use of tracheostomy, it is recommended to set a schedule of regular appointments for monitoring, especially for any complications. Notify the physician immediately if any of the following arises:
Tracheostomy ProcedureBefore the Procedure At the time that the doctor determines if the patient needs to have a tracheostomy and the patient decides to undergo the procedure, informed consent must be obtained. Also, the doctor needs to assess the neck’s range of motion. The team of doctors who will perform the procedure, including a surgeon, anesthesiologists, and others need to deliberate the entire sequence and if there’s an alternative to the operation. An organized and strict procedure in preparation and actual surgery is applied and maintained to avoid any incidence of procedural complications. During the Procedure During the surgery, the anesthesiologist is in charge of airway management, facilitates intravenous sedation, and performs bronchoscopy. An intubation roll, cricoid hook, and tracheostomy set are also at hand. The patient is placed in a lying position, the neck is extended unless contraindicated. Anesthesia will be provided as directed by the anesthesiologist. A small cut is performed onto the tissue to push down the thyroid isthmus. Next, bronchoscopy is performed to identify the best side to introduce the needle. The needle is placed at the lower edge of the light reflex, directed to the tracheal lumen to avoid the posterior tracheal wall. The tracheostomy tube is placed in the tracheal lumen under direct visualization. To confirm the placement, the bronchoscope is introduced to the tracheostomy tube and placement is confirmed by seeing the carina. To secure the tube, 2 sutures of 2-0 nylon on both sides of the flange. To make it more secure, tracheostomy tape is added to hold the tube in place.
The tracheostomy tube, the stoma and the skin surrounding it need special care to prevent complications. Before being discharged from the hospital, the nurse will demonstrate to the patient the proper way of taking care of the tracheostomy tube. Routine tracheostomy care should be done at least once a day or as necessary. The following are the step-by-step procedures in tracheostomy care.
2. Suctioning a Tracheostomy Tube Tracheal suctioning is done to remove mucus stuck in the tracheostomy tube to prevent blockage in the tracheostomy tube. It also removes secretion in the airway, to maintain clear and patent air passage. If done properly and cautiously, suctioning is a life-saving procedure by decreasing the risk of infection, build-up of secretions, and decreasing the level of oxygen. Indications of tracheal suctioning include the presence of secretions that can be visually or audible by hearing noisy respiration, signs of airway obstruction such as expanded breath sounds during expiration, an increase in respiratory effort, below-normal oxygen saturation, restlessness, and chronic cough. Below is the step-by-step procedure when suctioning a tracheostomy tube:
3. Emergency Care of a Tracheostomy Tube
Nursing Diagnosis for TracheostomyTracheostomy Nursing Care Plan 1Ineffective Airway Clearance related to thick and copious respiratory secretions secondary to tracheostomy as evidenced by the patient being postoperative from tracheostomy placement, ineffective cough, shortness of breath, and presence of crackles and rhonchi on auscultation. Desired Outcome: The patient will demonstrate clear airways and normal breath sounds by discharge.
Tracheostomy Nursing Care Plan 2Risk for Impaired Gas Exchange Diagnosis: Risk for Impaired Gas Exchange related to thickened tracheal secretions secondary to tracheostomy. Desired Outcomes: The patient will sustain a sufficient gas exchange, arterial blood gas result is within the normal range and will show no signs of desaturation, oxygen saturation is maintained at 90% and greater, relaxed breathing, and alert level of consciousness.
Tracheostomy Nursing Care Plan 3Risk for Infection Diagnosis: Risk for Infection related to surgical incision of tracheostomy secondary to tracheostomy. Desired Outcomes: The patient will be negative from any infection, as shown by normal body temperature, normal sputum culture, normal results in white blood cell count, clear breath sounds, and clean stoma without any presence of drainage.
Tracheostomy Nursing Care Plan 4Risk for Aspiration Diagnosis: Risk for Aspiration related to the presence of tracheostomy tube Desired Outcomes: The patient will not have an instance of aspiration and can eat and drink without coughing, choking, or presence of skin discoloration.
Tracheostomy Nursing Care Plan 5Risk for Injury Diagnosis: Risk for Injury related to tracheostomy care Desired Outcomes: The patient will demonstrate the absence of restlessness, difficulty breathing and the tracheostomy tube will remain patent and in place.
Nursing ReferencesAckley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon Disclaimer:Please follow your facilities guidelines, policies, and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. What are nursing interventions for a patient with a tracheostomy?(See Tracheostomy tubes.) When caring for a patient with a tracheostomy, nursing care includes suctioning the patient, cleaning the skin around the stoma, providing oral hygiene, and assessing for complications. Normal functions of the upper airway include warming, filtering, and humidifying inspired air.
What nursing intervention could be implemented to decrease risk for aspiration?Mixing pills with food helps reduce risk for aspiration. Stop continual feeding temporarily when turning or moving patient. When turning or moving a patient, it is difficult to keep the head elevated to prevent regurgitation and possible aspiration. Provide oral care before and after meals.
What are the nursing interventions to prevent complications with tracheostomy tubes?Apply eye protection. Perform hand hygiene, apply non-sterile gloves. Suction the oropharynx if indicated to remove any pooled secretions before cuff deflation to minimize risk of aspiration. Perform routine tracheostomy tube suction procedure.
Why are tracheostomy at risk for aspiration?Patients with tracheostomy are at a high risk for aspiration, which can occur for various reasons, such as pharyngeal pooling of secretions above the airway cuff, decreased laryngeal elevation, desensitization of the larynx, and loss of protective reflexes.
|