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General Practice 2023

Tracheostomy: what é, what it is for and care

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Tracheostomy: what é, what it is for and care
Tracheostomy: what é, what it is for and care

Tracheostomy consists of a small hole that is made in the throat, over the region of the trachea, where a tube is inserted to facilitate the entry of air into the lungs when the normal way of breathing is blocked or there is a reduction in the passage. donate. In some cases, the tracheostomy tube may be connected to a machine to deliver oxygen.

Tracheostomy is usually performed in the hospital by the doctor and is indicated in cases of throat tumor, paralysis due to neurological problems, traumatic injury to the face or neck, anaphylactic reactions or severe infection by COVID-19, for example, which can be maintained for just a few days or for life, depending on the cause.

If it is necessary to maintain the tracheostomy for a long time, it is important to know how to take care of it properly, to avoid serious complications such as asphyxia or even a lung infection.This care can be done by the caregiver, when the person is bedridden, or by the person himself, when he feels capable.

What is it for

Tracheostomy is indicated to facilitate the entry of air into the lungs or to provide oxygen, helping to keep breathing and pulmonary airways open.

Tracheostomy is usually indicated in the following situations:

  • Congenital malformations of the larynx;
  • Presence of foreign body in the upper respiratory tract;
  • Trauma or preparation for head and neck surgery;
  • Cancer of throat, larynx, pharynx or upper trachea;
  • Vocal cord paralysis;
  • Prolonged orotracheal intubation, usually longer than 1 or 2 weeks;
  • Edema of the glottis due to burns, infections or anaphylactic reaction;
  • Obstructive sleep apnea syndrome.

In addition, tracheostomy may also be indicated to suction and clear the airways in cases of paralysis or neurological problems that make it difficult for the person to cough and clear mucus from the throat or trachea.

Tracheostomy may also be indicated for people hospitalized with severe COVID-19 infection, using mechanical ventilation. See how COVID-19 is treated.

How is tracheostomy performed

Tracheostomy is performed through surgery in the hospital under general anesthesia, although in some cases the doctor may also opt for local anesthesia, depending on the difficulty and duration of the procedure.

Next, a small cut is made in the throat to expose the trachea and a new cut is made in the cartilage of the trachea to allow the tracheostomy tube to pass through. Finally, in a first phase or if the person just needs the tracheostomy in the hospital, machines can also be turned on to help with breathing.

Although you can go home with a tracheostomy, this procedure is generally used more in people with more serious problems who need to stay in the ICU for a long time, for example.

Tracheostomy care

To avoid the risk of serious complications, it is important to keep the tracheostomy tube, known as a cannula, always clean and free of secretions, as well as to change all tracheostomy components, according to the doctor's instructions.

Furthermore, it is essential to observe if the tracheostomy site is red, swollen or releasing some type of fluid, because if you present these signs it may indicate the emergence of an infection, which should be immediately reported to the doctor.

1. How to keep the cannula clean

To keep the tracheostomy tube clean and free of secretions, which can cause asphyxia or infections, you must:

  1. Put on clean gloves;
  2. Remove the inner cannula and place it in a container with soap and water for 5 minutes;
  3. Aspirate the inside of the external cannula with a secretion aspirator. If a secretion aspirator is not available, 2 mL of saline solution can be injected into the external cannula, if the person is able to cough, to provoke a cough and remove the secretions accumulated in the airways;
  4. Place a clean and sterilized inner cannula;
  5. Scrub the removed dirty inner cannula, inside and out, using a sponge or a brush;
  6. Place the dirty cannula in boiling water for about 10 minutes;
  7. Dry the cannula with sterile compresses and store it in a container disinfected with alcohol, to be used in the next exchange.

The tracheostomy outer tube should only be changed by a he althcare professional, as there is a high risk of the tracheostomy hole closing and causing asphyxia.Thus, one should go to the hospital at least once a week to change the entire tracheostomy set, or as directed by the doctor.

2. How to change the padded surface

The padded surface of the tracheostomy, which protects the tube from contacting the skin directly, should be changed whenever it is dirty or wet. After removing the dirty padded surface, clean the skin around the tracheostomy with a little saline solution and apply a fragrance-free moisturizing cream.

To place a new pillow, you can use tracheostomy pillows, as shown in the first image, or use 2 clean compresses with a cut at the top, as shown in the image.

Warning signs to go to the doctor

Some signs that indicate that you should immediately go to the hospital or emergency room are:

  • Difficulty breathing through the tube;
  • Tracheostomy pain or discomfort;
  • Clogging of the external cannula by secretions;
  • Accidental exit of the external cannula;
  • Change in tube position;
  • Presence of bloody phlegm;
  • Bleeding at the tracheostomy site;
  • Presence of signs of infection, such as redness or swelling of the skin around the tracheostomy.

When the person has only a slight sensation of shortness of breath, try removing the inner cannula and cleaning it properly. However, if the symptom persists, you should immediately go to the emergency room.

Possible complications

Tracheostomy is generally safe, but as it is a surgical procedure, it may have some complications that may occur during or shortly after surgery, such as:

  • Bleeding;
  • Pulmonary edema;
  • Damage to the trachea, thyroid gland, or nerves in the neck;
  • Incorrect placement or displacement of the tube;
  • Subcutaneous emphysema, which is air trapped under the skin of the neck;
  • Pneumothorax which is the accumulation of air between the chest wall and the lungs;
  • Hematoma formation on the neck that can compress the trachea.

These complications are greater when tracheostomy is performed due to a medical emergency, as it must be done quickly and with available materials, as in cases of glottic edema, for example.

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