Tracheostomy is a surgical procedure to create an opening in the throat to facilitate breathing. It may be done under general anesthetic and usually takes place in an operating room or another medical setting.
Tracheostomy care requires scientific knowledge, sterile technique, and problem-solving abilities. Nurses provide this care in many medical scenarios such as respiratory failure, trauma, and surgery.
Seldinger Technique
The Seldinger Technique is an advanced tracheostomy training technique suitable for healthcare professionals with some basic training in this area. This procedure utilizes a guidewire to precisely insert the endotracheal tube into a patient’s trachea, minimizing bleeding and surgical emphysema.
This minimally invasive technique for tracheostomy is frequently employed as part of a bronchoscopy procedure in patients with upper airway obstruction or difficulty breathing on their own. Furthermore, the Seldinger Technique offers the advantage of being less disruptive to the respiratory tract than using a scalpel.
When you are ready for a tracheostomy, your healthcare provider will make an incision (cut) in your neck that goes through your trachea (windpipe). Then they will open the hole to insert a tracheostomy tube inside it which is secured with tape around your neck so it cannot move out of place.
Before your tracheostomy procedure, it is necessary to take certain medications in order to protect against infections. These may include acetaminophen or ibuprofen and may help with pain, nausea or vomiting as well.
Once your tracheostomy surgery is completed, your medical team will monitor you closely to make sure everything is going smoothly. They may give instructions about how to care for it properly. It’s likely that you need to stay in the hospital for a few days up to a few weeks after your surgery.
If you suffer from severe upper respiratory infections, your healthcare provider may suggest a laryngectomy tracheostomy procedure. This involves surgical removal of the larynx (voice box) as well as nerve removal that moves vocal cords.
Another option for tracheostomy is percutaneous tracheostomy (PTD). This procedure has become increasingly popular in the intensive care unit (ICU) due to its ease of bedside application, avoidance of transporting critically ill patients, and potential reduction in cost and time required for surgical tracheostomy.
In the ICU, tracheostomies are frequently performed to alleviate upper airway obstruction, protect the tracheobronchial tree, provide access for long-term positive pressure ventilation or wean from mechanical ventilation. Unfortunately, complications, morbidity, and mortality rates associated with surgical tracheostomy are comparable.
Positioning the Tube
Healthcare professionals who have already undergone some basic tracheostomy training and wish to advance their skills and knowledge can utilize several advanced tracheostomy techniques. These include the Seldinger technique, positioning of the tube during reintubation and more.
Positioning of the tracheostomy tube is an integral step in all tracheostomy procedures and requires advanced skill and knowledge for patient safety. The technique involves using both curved dilators and straight dilators to dilate the trachea.
First, insert an introducer needle through the anterior wall of the trachea under direct bronchoscopic visualization (Fig. 1). Insert it at or near the level of the second tracheal ring perpendicular to the trachea with its bevel facing down; this helps avoid potential damage to guiding catheter during insertion and complications like stenosis.
Once the introducer is inserted, visualize the guidewire as it advances distally toward the carina (Fig. 2). Next, advance a small tracheal dilator over this wire to dilate the trachea.
Next, advance the single-stage progressive dilator over its wire and protective sheath until it reaches your desired depth. Markings on the side of the dilator indicate where to place it for accurate placement of the dilator.
Repeat this process until the dilator reaches its destination, and then insert an appropriate-sized tracheostomy tube over the wire and protective sheath. Measure breath sounds returned tidal volume, and cuff pressure once positioned to confirm the patient is receiving adequate ventilation.
In some rare cases, a tracheostomy tube may be accidentally dislodged by the body and pulled back from its normal location. This can be an uncomfortable situation for patients and should be addressed with traction sutures.
When changing a tracheostomy tube, two people should be involved to guarantee the new ties are securely in place. One person holds the tube while the other takes out any existing Velcro ties and replaces them with fresh ones.
Reintubation
Tracheostomy is a surgical procedure that creates an opening in the trachea to allow for breathing. This type of procedure is usually done in an emergency at a hospital or before surgery and can be particularly beneficial for individuals with COVID-19 and other respiratory conditions that pose risks of airway obstruction.
Tracheostomies can also benefit those on mechanical ventilation, as the tube keeps the trachea open so air can enter your lungs. Not only does this improve breathing, but it may also enhance the quality of life for you and those around you.
In addition to the surgical procedures involved, tracheostomies require ongoing care and management by healthcare professionals. It is essential that all personnel responsible for caring for a tracheostomy patient possess the necessary skills and knowledge in order to carry out their role efficiently.
It is essential that healthcare providers who are unfamiliar with the process receive adequate training in order to avoid complications and minimize the potential risk of harming patients. This can be achieved through a training course designed to guarantee healthcare professionals have the capacity to handle situations safely and effectively.
Studies have demonstrated the benefits of training programs for healthcare providers. Dorton et al1 demonstrated that those with minimal experience in tracheostomy care and complications reported significantly greater levels of knowledge after attending an education module. Agarwal et al13 observed similar effects, finding simulation-based programs improved comfort with routine tracheostomy tube care as well as the capacity to objectively assess airway problems.
Although many healthcare professionals are familiar with tracheostomies, there is still room to enhance their knowledge. Attending a tracheostomy training course can give them the skillset needed to perform advanced techniques such as reintubation.
This course will give healthcare professionals a comprehensive knowledge of the anatomy and physiology involved in inserting and caring for a tracheostomy, as well as emergency procedures and troubleshooting skills. At the conclusion, learners will receive certification in Tracheostomy Care.
Closure
Tracheostomy is an essential step in the management of patients with complex airway disease. It is performed by a range of professionals and can have a lasting effect on patient quality of life. Despite improvements made in tracheostomy care over time, there remain obstacles that must still be overcome to ensure positive outcomes for those affected by this condition.
These issues may include high mortality rates, intractable coughs, and tracheal tube complications like stenosis. Fortunately, these risks can be minimized through proper tracheostomy management.
Promoting best-practice tracheostomy care requires effective collaboration between healthcare professionals. This includes creating care pathways that ensure continuity between critical care and ward clinicians, as well as decannulation and discharge planning. Furthermore, all bedside staff caring for tracheostomy patients must be competent to recognize and manage common airway complications like tube obstruction or displacement.
In order to promote the advancement of tracheostomy care worldwide, the Global Tracheostomy Collaborative (GTC) has created a longitudinal database that collects clinical outcomes data from member institutions over time. This will permit comprehensive statistical analysis and ultimately lead to improvements in tracheostomy outcomes overall.
The GTC is a collaborative group of healthcare professionals dedicated to improving the care of those with a tracheostomy. This includes experts from nursing, anesthesia and critical care, surgery, respiratory therapy, and speech-language pathology from across different continents.
To facilitate this, the GTC created a secure web-based system for entering data on retrospective clinical outcomes for each tracheostomy insertion performed within its member hospitals. The GTC will then compile and analyze this information to inform its quality improvement initiatives as well as research activities.
As part of its work, the GTC has created webinars and online discussion groups to offer practical applications and expertise on key tracheostomy quality issues. These are excellent platforms for tracheostomy teams to connect and develop best practices.
Ultimately, the purpose of tracheostomy care is to guarantee patients receive prompt and efficient treatment. This requires ensuring all staff members have received training on caring for tracheostomy patients, as well as having access to necessary equipment at their bedside.
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