This blog post covers temporary tracheostomy placement as well as care.
Firstly, this is a link to a video I made on the procedure to place a temporary tracheostomy. Always take a lateral radiograph at the completion of the procedure to check where the tube lies in the trachea.
This is the video that outlines how to make a temporary tracheostomy tube from a sterile endotracheal tube
Care of The Tracheostomy Tube
Equipment to Keep at the Cage Side:
Gloves
Sterile tracheostomy tube (appropriate size)
Suction machine (with dog urinary catheter, adapter, and suction tip)
Cotton buds
Swabs
Sterile saline (NaCl 0.9%) for cleaning
Water for injection (WFI)
Nebuliser
Adrenaline 1:1000 vials
Sedation protocol (as directed by the anaesthesia team)
Emergency Trolley Equipment:
ET tubes and replacement tracheostomy tubes
Induction agent drawn up and ready
Needle and syringe
Cuff syringe for inflating cuff on temporary tracheostomy tube if needed
Knit-fix tie replacement, for holding the tube in place around the neck
Swabs
Laryngoscope
Oxygen supply
NaCl flush
Tracheostomy ongoing care:
Glove Use: Always wear gloves when handling tracheostomy tubes.
Nebulisation: Nebulise the tracheostomy tube site with sterile WFI for 10 minutes every 4 hours (or as directed by the clinician - I prefer to do it more frequently, even up to hourly) to humidify the airways. Adrenaline (0.5ml of 1:1000 with 4.5ml WFI) may be added as per the anaesthetist’s or surgeon's instructions.
Cleaning the Tube: Moisten cotton buds with NaCl 0.9% and gently clean the inside of the tracheostomy tube. Take care not to obstruct the airway for too long, and remove any secretions.
Tracheostomy Site Care: Clean the skin around the tracheostomy site with sterile NaCl 0.9%, then gently dry. This should be done every 2 hours initially, and every 4-6 hours later, depending on the amount of secretions.
Wipe: Wipe the area around the tracheostomy with a diluted solution of chlorhexidine, then dry thoroughly.
Barrier Cream: Apply barrier cream around the tracheostomy site, if recommended by the clinician.
Close Monitoring: Continuously monitor the patient, as the tracheostomy tube can become obstructed or dislodged unexpectedly.
Emergency Tube Availability: Keep a sterile tracheostomy tube readily available in case of obstruction or dislodgement that requires immediate replacement.
Routine Tube Replacement: Replace the tracheostomy tube every 12-24 hours, or as directed by the clinician, in collaboration with the surgeon.
Securing the Tube: Ensure the tracheostomy tube is securely fastened behind the neck. The securing material should be changed if it becomes soiled.
Aseptic Technique: Maintain strict aseptic technique when replacing the tracheostomy tube.
Oxygen Support: Keep flow-by oxygen available at 5 L/min at all times.
Suctioning: Periodically suction the airways as needed to remove secretions, but only when there is clinical evidence of airway obstruction. Prolonged suctioning can cause mucosal injury. A urinary catheter may be attached to the suction tube with a Christmas-tree adapter. Limit suctioning to 10-15 seconds to prevent hypoxia and use a clean catheter each time.
Positioning: Ensure recumbent patients are positioned to allow unobstructed airflow through the tracheostomy tube.
Stomach: Ideally ensure there is no significant ileus or delayed gastric emptying, and consider the placement of a feeding tube to empty stomach as required.
Documentation: Record all observations and procedures on the hospital sheet.
Tips:
Positioning Support: Pillows and blankets may be necessary to help patients with tracheostomy tubes rest comfortably, as they may be reluctant to lie flat.
Infection Monitoring: Watch for signs of infection, such as inflammation or purulent discharge, around the tracheostomy site.
Tracheal Injury: Be alert for signs of emphysema, which could indicate a tracheal tear.
Respiratory Monitoring: Continuously monitor for signs of respiratory distress or abnormal effort.
Emergency Equipment: Ensure suction and oxygen are readily available near the patient at all times.
In our experience, the use of an ET tube fashioned into a temporary tracheostomy tube has the advantage of being less prone to blockage, is longer (so better for thick necks), and is a better shape versus commercial tubes.
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