Tracheotomy, Assisting
A tracheotomy involves the surgical creation of an external opening—called a tracheostomy—into the trachea and insertion of an indwelling tube to maintain the airway’s patency. If all other attempts to establish an airway have failed, a doctor may perform a tracheotomy at a patient’s bedside. This procedure may be necessary when an airway obstruction results from laryngeal edema, foreign-body obstruction, or a tumor. An emergency tracheotomy also may be performed when endotracheal intubation is contraindicated.
Use of a cuffed tracheostomy tube provides and maintains a patent airway, prevents the unconscious or paralyzed patient from aspirating food or secretions, allows removal of tracheobronchial secretions from the patient unable to cough, replaces an endotracheal tube, and permits the use of positive-pressure ventilation.
When laryngectomy accompanies a tracheostomy, a laryngectomy tube—a shorter version of a tracheostomy tube—may be inserted by the doctor. In addition, the patient’s trachea is sutured to the skin surface. Consequently, with a laryngectomy, accidental tube expulsion doesn’t precipitate immediate closure of the tracheal opening. When healing occurs, the patient has a permanent neck stoma through which respiration takes place.
Although tracheostomy tubes come in plastic and metal, plastic tubes are much more commonly used because they have a universal adapter for respiratory support equipment, such as a mechanical ventilator, and a cuff to allow positive-pressure ventilation.
Equipment
Tracheostomy tube of the proper size with obturator ▪ sterile tracheotomy tray (typically contains tracheal dilator, vein retractor, hemostats, and clamps) ▪ sutures and needles ▪ 4″ × 4″ gauze pads
▪ gloves ▪ sterile drapes, gloves, mask, and gown ▪ sterile bowls ▪ stethoscope ▪ dressing ▪ pillow ▪ tracheostomy ties ▪ suction apparatus and tubing ▪ alcohol pad ▪ antiseptic cleaning solution ▪ sterile water ▪ 5-mL syringe with 22G needle ▪ local anesthetic (such as lidocaine with epinephrine) ▪ oxygen therapy device ▪ oxygen source ▪ syringe for cuff inflation.
▪ gloves ▪ sterile drapes, gloves, mask, and gown ▪ sterile bowls ▪ stethoscope ▪ dressing ▪ pillow ▪ tracheostomy ties ▪ suction apparatus and tubing ▪ alcohol pad ▪ antiseptic cleaning solution ▪ sterile water ▪ 5-mL syringe with 22G needle ▪ local anesthetic (such as lidocaine with epinephrine) ▪ oxygen therapy device ▪ oxygen source ▪ syringe for cuff inflation.
Many facilities use prepackaged sterile tracheotomy trays.
Preparation of Equipment
Have one person stay with the patient while another obtains the necessary equipment. Perform hand hygiene.1,2,3,4 Then, maintaining sterile technique, open the tray.1,2,3 Take the tracheostomy tube from its container and place it on the sterile field. If necessary, set up the suction equipment and make sure it works. When the doctor opens the sterile bowls, pour in the antiseptic cleaning solution.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.5
Explain the procedure to the patient even if he’s unresponsive.
If possible, make sure that an informed consent has been obtained and is documented in the medical record.6
Conduct a preprocedure verification process to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient’s identifiers.7
Assess the patient’s condition and provide privacy. Maintain ventilation until the tracheotomy is performed.
Make sure the patient has patent IV access; insert an IV catheter if necessary.8
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