Tracheostomy Types
Surgical vs percutaneous. Cuffed vs uncuffed. Fenestrated (allows speech). Inner cannula (disposable or reusable for cleaning). Speaking valves (Passy-Muir) allow speech when cuff deflated. Trach sizes: ID measured in mm. Trach changes: first change by surgeon (7-10 days), then by trained nurse/RT.
Routine Care
Suctioning: pre-oxygenate, sterile technique, insert without suction, apply suction on withdrawal, max 10-15 sec per pass, max 3 passes. Suction depth: shallow (1 cm past tip), deep (carina). Inner cannula: clean or change q8h. Stoma care: clean with half-strength peroxide or NS, assess for breakdown, infection, granulation. Dressing: trach dressing (split gauze), change when soiled. Humidification: trach collar, HME. Cuff: maintain pressure 20-25 cmH2O, check q8h.
Emergencies
Accidental decannulation: if <7 days (immature tract), do not reinsert — call for help, use bag-valve-mask over stoma, cover stoma. If mature: reinsert obturator and trach, remove obturator, insert inner cannula, secure. Mucus plug: attempt suction, if unable, remove inner cannula, emergency bronchoscopy. Bleeding: minor (suction, pressure), major (call surgeon, tracheoinnominate fistula is life-threatening).
Important Notes
- For accidental decannulation within first 7 days (immature tract), do NOT reinsert — cover stoma, bag-valve-mask, call for help.
- Never suction for more than 10-15 seconds per pass — prolonged suctioning causes hypoxia and bradycardia.
Clinical Tips
- Tracheostomy cuff pressure should be 20-25 cmH2O — too high causes mucosal damage, too low causes aspiration.
- Tracheoinnominate fistula: sudden massive bleeding from trach — life-threatening, hyperinflate cuff, call surgeon STAT.
Summary
Tracheostomy care requires sterile suctioning (max 10-15 sec), inner cannula care, stoma care, cuff pressure monitoring, and emergency preparedness.
