Content area
Full Text
Abstract
Tracheostomy care is a complex nursing activity and has many potential complications. However, aspects of tracheostomy care appear to be carried out without uniformity and with some confusion as to correct techniques, especially outside the ear, nose and throat and Intensive care environments. Some aspects of the literature appear contradictory, leaving nurses to make individual judgments about correct procedures. It is the nurse who Is accountable for the care given; therefore, with the wealth of evidence available, it is important that the nurse is adequately trained and fully competent in the care of a patient with a tracheostomy. This article discusses particular aspects of tracheostomy care: assessment; tracheal suctioning; suction pressure; suction catheters; and humidity.
Tracheostomy procedures are widely performed by ear, nose and throat (ENT) surgeons for major surgical procedures of the mouth, pharynx and larynx and in emergency cases such as obstruction of the trachea (Figure 1). Tracheal suctioning is frequently a necessary intervention in the management of a patient with a tracheostomy. As the upper airway is bypassed in a patient with a tracheostomy, some form of humidification must also be provided. It is important for nurses to be adequately educated in caring for these patients.
According to Hooper (1996), suctioning is required for two reasons:
Having a tracheostomy prevents the patient from increasing his/her intra-abdominal pressure sufficiently to cough and clear any secretions from his/her airway Initially, the tracheostomy tube may cause irritation, resulting in an increased production of sputum.
All tracheostomy patients will require suctioning, some more than others, and although it may be considered a routine procedure, it can cause complications if carried out incorrectly (Table 1).
Shekelton and Nield (1987) comment that:
`Given the serious nature of the potential consequences of suctioning, the clinician should base suction protocols on solid clinical research data, which indicate the safest, least traumatic suctioning technique.'
Much has been written on the principles of suctioning, but suction techniques are variable and principles are not always followed, resulting in risks to patients (GrossbachLandis and McClane, 1979; DeCarle, 1985; Odell et al, 1993). Suctioning is therefore an essential part of the total care required by an individual patient. This article discusses particular aspects of tracheostomy care, including assessment, suctioning, suction pressure, catheters and...