ENDOTRACHEAL INTUBATION

DEFINITION:
It is the placement of a tube into the trachea (windpipe) in order to maintain an
open airway in patients who are unconscious or unable to breathe on their own.
Oxygen, anesthetics, or other gaseous medications can be delivered through the
tube.
INDICATIONS FOR ENDOTRACHEAL INTUBATION:
Respiratory:
 Apnoea
 Acute respiratory failure (PaO2<50 mm and PaCO2 > 55 mm Hg)
 To control oxygen delivery( eg. Institution of positive end- expiratory
pressure [ PEEP])
 ❖To control ventilation (eg, to decrease work of breathing, to control
PaCO2)
 Cardiopulmonary arrest
 Upper airway obstruction
 Trauma to the airway
 Burns (concern for airway edema)
Neurologic
 Inadequate chest wall function (eg, in patient with Guilain Barre syndrome)
 Absence of protective airway reflexes (eg.cough, gag).
 Glassgow coma score 8.
Others:
 During anaesthesia
 Poisoning
 Anaphylactic reaction
ROUTES OF ENDOTRACHEAL INTUBATION
 Endotracheal Intubation
 Oro tracheal intubation
 Naso tracheal intubation
REQUIRED EQUIPMENT:
1. Endotracheal tube
 Size of tube is dependent on size of patient
 7.5 mm is the "Universally Accepted" size for an unknown victim
 Men are usually larger, therefore an 80 mm tube may be appropriate
 Females are usually smaller, therefore a 70 mm tube may be appropriate
2. 10 cc Syringe used to fill the cuff at the end of the endotracheal tube
3. Stylet wire inserted into the endotracheal tube in order to stiffen it during
passage
4. Water soluble lubrication KY Jelly
5. Stethoscope to check for proper placement of the endotracheal tube
6. Laryngoscope handle
7. Laryngoscope blade
8. Straight blade
9. Curved blade
10. Oropharyngeal airway (bite block)- to prevent the patient from biting down on
the endotracheal tube
11. Tape to secure the endotracheal tube in place
12. Gloves
13. Ambu-bag-to facilitate positive pressure ventilations
14 Suction Device to clear the airway of debris (blood, mucous, saliva)
FORMULA FOR ENDOTRACHEAL TUBE INSERTION:
 Predicted Size uncuffed tube (age 4)-4
 Predicted Size cuffed tube (age 4)+3
 Internal diameter of tube (mm) (patient age in years 4)+6
 Depth of insertion (cm) 12+(patient age in years 2)
PATIENT PREPARATION
 Administer medication as ordered to decrease respiratory secretions, induce
amnesia analgesia and help calm and relax conscious patient
 Remove dentures if present
 Administer oxygen until tube is inserted to prevent hypoxia
 Place patient supine in sniffing position so that his mouth, pharynx and
trachea are extended
 Put on gloves
 For oral intubation spray local anaesthetic deep into patient posterior
pharynx to diminish gag reflex and reduce patient's discomfort
 If necessary suction patient's pharynx just before tube insertion
 Time each intubation attempt, limiting attempts to less than 30 seconds.
 Stand at head of patient's bed. Using your right hand hold patient's mouth
open by crossing your index finger, hold patient's mouth open by crossing
your index finger over your thumb on patient's upper teeth and your index
finger on his lower teeth.
 Grasp the laryngoscope handle in your left hand and gently slide the blade
into right side of patient's mouth.
 Center the blade and push the patient's tongue to left. Hold patient's lower
lip away from his teeth to prevent lip from being traumatized
 Advance the blade to expose epiglottis
 Lift laryngoscope handle upward and away from your body at a 45-degree
angle to reveal vocal cords
 If desired, have an assistant apply pressure to cricoid cartilage to occlude
esophagus and minimize gastric regurgitation
 When performing an oral intubation, insert ET tube into right side of
patient's mouth. When performing a nasotracheal intubation, insert ET tube
through nostril and into pharynx
 Guide tube into vertical openings of larynx between the vocal cords If vocal
cords are closed because of spasm wait a few seconds them to relax and then
gently guide tube past them to avoid traumatic injury
 Advance tube until cuff disappears beyond the vocal cords
 Holding the ET tube in place, quickly remove stylet if present
BLIND NASOTRACHEAL INTUBATION
 Pass the ET tube along the floor of nasal cavity. If necessary use gentle force
to pass tube through nasopharynx and into the pharynx.
 Listen and feel for air movement through tube as it is advanced to ensure
that tube is properly placed in airway
 Slip the tube between vocal cords when patient inhales
 Once the tube is past the vocal cords, the breath sounds become louder. If at
any time during advancement breath sounds disappear, withdraw the tube
until they reappear
AFTER INTUBATION
 Inflate tube's cuff with 5-10 cc of air until you feel resistance
 Remove the laryngoscope if patient was intubated orally insert an oral
airway to prevent patient from obstructing airflow or puncturing tube with
his teeth
 To ensure correct tube placement observe for chest expansion and auscultate
for bilateral breath sounds feel tube's tip for warm exhalations and listen for
air movement
 If you don't hear any breath sounds, auscultate over stomach while
ventilating with resuscitation bag. If you don't hear any breath sounds
auscultate over stomach while ventilating with resuscitation bag. Stomach
distension, belching or gurgling sound indicates esophageal intubation.
Immediately deflate cuff and remove the tube
 Auscultate bilaterally to exclude possibility of endotracheal intubation.
 Once you have confirmed correct tube placement administer oxygen or
initiate mechanical ventilation. And suction if indicated
 To secure tube position applies benzoin tincture to apply cheek and let it dry
for enhanced tape adhesion
 Inflate the cuff with minimal leak technique or minimal occlusive volume
technique
 Clearly note centimeter marking on tube at point where tube exits patient's
mouth or nose
 Make sure that chest X ray is taken to verify tube position
  Place patient on his side with his head in a comfortable position to avoid
tube kinking
 Auscultate bilaterally to exclude possibility of endotracheal intubation.
 Give frequent oral care to orally intubated patient position ET tube
 Suction secretions through ET tube to clear secretions and prevent mucus
plugs from obstructing tube
COMPLICATIONS-
 Apnea
 Aspiration of blood, secretions or gastric contents
 Bronchospasm
 Injury to lips mouth, pharynx or vocal cords
 Laryngeal edema and erosion
 Tooth damage or loss
 Tracheal stenosis, erosion and necrosis
CONTRAINDICATIONS
 Obstruction of the upper airway due to foreign objects
 Cervical fractures
The following conditions require caution before attempting to intubate
 Esophageal disease
 Ingestion of caustic substances
 Mandibular fractures
 Laryngeal edema
 Thermal or chemical burns
NURSING CONSIDERATIONS
 Maintain exact tube placement and tube must be well secured to avid
kinking and prevent bronchial obstruction and accidental extubation.
 Use the minimal leak technique to avoid tracheal erosion and necrosis
 Always record volume of air needed to inflate cuff gradual increase in
volume indicates tracheal dilatation or erosion
 sudden increase in volume indicates rupture of cuff and requires immediate
reintubation
  Once the cuff has been inflated, measure its pressure at least every 8 hours to
avoid overinflation (normal cuff pressure is about 18 mmHg)
 Record date and time of procedure, its indications and success or failure.
Tube type and size, cuff size, amount of inflation, initation of supplemental
oxygen or ventilator therapy and results of chest x ray
 Record any complications and nursing action taken
 Note patient reaction to procedure
BIBLIOGRAPHY
 Brunner and suddarth Textbook of medical Surgical Nursing. Edition 10.
Page No- 985-987
 Lewis Heitkemper Medical Surgical Nursing Assessment & management of
clinical problems. 7 Edition Page No.-1750-1752
 Cathy goldberg, Peter Johnson handbook of clinical skills edition 7 page no-
299-306
NET REFERENCE
https://www.healthline.com
https://my.clevelandclinic.org
 MECHANICAL VENTILATOR
INTRODUCTION:
Mechanical ventilator may be required for a variety of reasons including the need
to control the patient respiration during surgery or during treatment of severe head
injury, to oxygenate the blood when the patient's ventilator efforts are inadequate
and to rest the respiratory muscles. Caring for the patient on Mechanical ventilator
has become a integral part of nursing care in critical care or general medical
surgical unit.
MECHANICAL VENTILATOR:
A Mechanical ventilator is a positive or negative pressure breathing device that can
maintain ventilation and oxygen delivery for a prolonged period
INDICATION:
 Neuro muscular disease
 Central nervous system disease.
 CNS depression,
 Musculo skeletal disease.
 Inefficiency of thoracic cage in generating pressure gradiant necessary for
ventilation,
 Drug overdose
 Inhalation injury
 Multiple trauma
 Shock and coma,
 COPD
RISK FACTORS:
 Barotrauma.
 Ventilator assisted lung injury.
 Atrophy in diaphragm
TYPES MECHANICAL VENTILATORS
Transport ventilatorsThese ventilators are small, more rugged, and can be
powered pneumatically or via AC or DC power sources
Intensive-care ventilators
These ventilators are larger and usually run on AC power(though virtually all
contain a battery to facilitate intra-facility transport and as a back-up in the event
of a power failure). This style of ventilator often provides greater control of a wide
variety of ventilation parameters (such as inspiratory rise time). Many ICU
ventilators also incorporate graphics to provide visual feedback of each breath.
Neonatal ventilators
Designed with the preterm neonate in mind, these are a specialized subset of ICU
ventilators which are designed to deliver the smaller, more precise volumes and
pressures required to ventilate these patients
MODES OF VENTILATOR:
Mechanical ventilation utilizes several separate systems for ventilation referred to
as the"mode". Modes come in many different delivery concepts but all modes
generally fall into one of the few main flagship categories: Volume, pressure or
spontaneous control.
Volume controlled:
 Volume controlled systems of ventilation are based on a measured volume
variable which is set by the clinician.
 When the ventilator detects the set volume having been applied the
ventilator cycles to exhalation. This is measured various ways by each brand
and model.
 Some ventilators measure using a flow sensor at the circuit wye while some
measure where the expiratory circuit plugs into the expiratory port on the
ventilator body
Modes that can be volume controlled
 Continuous mandatory ventilation
 Intermittent mandatory ventilation
 Synchronized intermittent mandatory ventilation
 Mandatory minute volume
Pressure controlled
 Pressure controlled cycling is based on an applied positive pressure that is
set by the clinician
 In pressure conrolled modes the total volume is variable as the ventilator is
using only the pressure as a measurement for cycling
 Most ventilators calculate pressure at the expiratory circuit though some
measure near the circuit wye with a proximal pressure line
Modes that can be pressure controlled
 Continuous mandatory ventilation (CMV)
 Intermittent mandatory ventilation (IMV)
 Synchronized intermittent mandatory ventilation (SIMV)
 Mandatory minute dume (MMV)
 Airway pressure release ventilation (APRV)
Spontaneously controlled:
Spontaneously controlled cycling is a flow sensed mode dependant on a
spontaneously breathing patient to cycle. Spontaneously controlled ventilation is
typically only in reference to continuous spontaneous ventilation, also called
continuous positive airway pressure (CPAP)
Modes that can be spontaneously controlled
 Synchronized intermittent mandatory ventilation (SIMV)
 Airway pressure release ventilation (APRV)
 Biphasic positive airway pressure (BPAP)
 Continuous positive airway pressure (CPAP)
EQUIPMENTS:
 Airway,
 Mechanical ventilator,
 Ventilator circuit,
 Humidifier,
 Direction for specific machine
PROCEDURE
CARE OF THE AIRWAY
 It is of paramount importance that all cares and procedures are carried out
with maintaining a patent airway always in mind.
 Always check the patient first. Observe the patient’s facial expression,
colour, respiratory effort, vital signs and ECG tracing.
 Ensure the endotracheal tube (ETT) or tracheostomy tube is held securely in
position but not too tightly to result in pressure area lesions.
 Check the placement of the ETT by listening for equal bilateral breath
sounds, checking the CXR and noting the distance marks on the tube at the
teeth, checking the previously documented level.
 Check and adjust (if necessary) the cuff pressure of the ETT/trachia. In order
to minimize tracheal damage, the cuff pressure should be at the lowest
pressure necessary to prevent an air leak.
CHECK THE BEDSIDE EMERGENCY EQUIPMENT:
• An alternative means of ventilation eg. Laerdel bag must be available &
functional
• Yankeur sucker, suction catheters and functioning suction unit, airways and
masks should be available
VENTILATION:
• Ensure the ventilation tubing is not kinked and that it is adequately supported so
as not drag on the ETT/trachi. Take care of the tube while turning or moving the
patient.
• Check the ventilator and document the settings. Look at the alarm parameters
and reset if necessary.
• Ensure the ventilator and the cardiac monitor are plugged into emergency power
supply in case of power failure.
• Ensure that you have enough room to access the head of the bed in an emergency.
• Check the type of humidification, and when the filters and ventilation tubing
were last changed.
• HME filters and end expiratory filters are changed routinely (and marked with the
date and time) every 24 hours or more frequently if there is condensation visible.
• Ventilator circuits are changed weekly
.• Indications for an actively humidified circuit (Westmead ICU)
 minute volume greater than 10 litres
 chest trauma with pulmonary contusion
 airway burns
 severe asthma
 hypothermia (<34 C)
 Pulmonary haemorrhage
 severe sputum plugging/pulmonary oedema leading to HME occlusion
 consultant order
• Pooled secretions above the ETT/trachi cuff are associated with ventilator
associated pneumonia (VAP). This is a result of aspiration of bacteria colonizing
the oropharynx or GIT and subsequently leaking below the cuff into the trachea.
Therefore thorough oropharyngeal suctioning should be performed before letting
down the cuff to reposition the ETT or to check cuff pressure.
SUCTION OF AN ARTIFICIAL AIRWAY:
 To maintain a patent airway
 To promote improved gas exchange
 To obtain tracheal aspirate specimens
 To prevent effects of retained secretions eg. infection, atelectasis,
increased airway pressures or a blocked tube.
 It is important to oxygenate before and after suctioning
MONITORS:
• Check the level of any invasive monitoring transducers and zero them.
• Check the alarm parameters and reset if necessary
• Document the patient’s vital signs hourly and when there is a deviation
from the usual.
• Check and document a manual blood pressure to assess the accuracy of the
arterial trace once a shift.
ORAL CARE:
• The aim of oral care and assessment is to promote normal hygiene while
preventing infection and trauma.
• The presence of an ETT can cause hyper salivation in some patients and an
uncomfortably dry mouth in others.
• A soft toothbrush can be used for oral hygiene and a small amount of toothpaste
can help the cleansing action. Using large amounts of toothpaste may leave a
residual coating and produce a burning sensation if it is not rinsed away properly.
• Properly diluted sodium bicarbonate may be used to remove resistant coating on
the tongue, debris or tenacious secretions but again overuse may cause superficial
burns.
• The lips should be kept moisturized to stop them becoming sore and cracked
hourly oral care is recommended, using water, not saline, and oral swabs and
thorough suctioning of oral secretions, a toothbrush & paste should be used atleast
once a shift and more often if indicated
NURSES RESPONSIBILITY :
 Monitor & evaluate pt’s response to ventilator.
 Manage ventilator safely.
 Prevent complications Monitor O2 sat and CO2 monitor.
 Interpret ABG’s
 Assess breathing pattern Suction q 2 hrs and prn.
 Assess trach or ETT site. Q 4 hrs.
 Always make sure alarms are ―on
 Nursing care of ventilated patients monitor vital signs
 Continously ensure that the endotracheal tube plaster was fully secured
 Endo tracheal tube plaster should not be applied too tight over the jugular
area .
Eye Care:
 The unconscious, sedated or paralyzed patient is at risk of developing eye
problems ranging from mild conjunctivitis to serious corneal injury and
ulceration
 Sedation and muscle relaxants can lead to inadequate closure of the eye, lack
of random eye movements and a loss of the blink reflex, all of which can
lead to complications.
 Constrictive securing tapes can compromise venous return from the head
 second hourly eye care using saline soaked gauze to clean the eye and the
application of lactrilube regularly in the ventilated patient is recommended
to help reduce the risk of complications.
Gastro intestinal tract:
 Intubated patients must have a nasogastric tube for gastric decompression or
nutritional support.
 The presence of bowel sounds and the turgor of the abdomen should be
assessed during the initial assessment.
 Nutrition and hydration are essential to build respiratory muscle strength
fluid and electrolyte imbalance, intestinal fluid retention, weight loss,
pressure areas and poor wound healing.
 Patients with a functioning GI tract should be fed enterally. TPN may be
used if there are contraindications to enteral feeding.
 The enterally fed patient should be monitored for diarrhea, dehydration,
fluid overload, constipation or abdominal cramping. These observations can
be a guide in determining the strength and rate of increase of the feeds.
 NG tubes should be flushed with 20-30 mls of water before and after
administering medications.
 Fine bore tubes can not be aspirated but should be flushed 4 hourly with
water.
Genital/Urinary Tract:
 IDCs predisposes urinary tract infections
 Routine urinalysis should be twice a day
 Regular penil/perineum catheter care should be done
  The catheter should be secured to the leg carefully and repositioned as
necessary to prevent pressure area
 Hourly urine monitoring is carried out and medical staff informed
of abnormally high or low measurements. Aim for a urine output of
0.5ml/kg.
 Repositioning And Pressure Area Care:
 Attending to the patient’s hygiene protects the skin and ensures dignity and
comfort
 Ventilated patients are at a higher risk of developing nosocomial infections
and pressure areas due to their immobility, their underlying disease process

and the presence of invasive monitoring lines and equipment.

 Repositioning the patient regularly has a number of positive effects routine

turning and positioning assists in the mobilization of secretions
 Prevents the development of pressure areas, joint stiffness and deformities
 Improves oxygenation and can encourage weaning from the ventilator.
 provides a different view on the environment for the patient
 The patient should be repositioned 2 hourly if possible, taking care to
position the limbs in proper alignment and supporting them to prevent
dependant oedema.
 If the patient has leg splints on they should be on for 2 hours and off for 2
hours. They should not be bandaged and the skin integrity should be
checked with each turn
COMPLICATIONS:
 airway injury,
 alveolar damage
 pneumothorax
 ventilator- associated pneumonia.
CONCLUSION:
Mechanical ventilation is a method to mechanically assist or replace spontaneous
breathing. This may involve a machine called ventilator or the breathing may be
assisted by a physician, respiratory therapist or other suitable person compressing
a bag or set of bellows. There are two main divisions of mechanical ventilation:
invasive ventilation and non- invasive ventilation
BIBLIOGRAPHY
1. Naudeep kaur Brar, HC Rawat, “Textbook of Advanced Nursing Practice”,
jaypee Publications, pp: 967-974.
2.Samata Soni, “Text book of Advanced Nursing Practice”, jaypee publication,
first edition pp: 300-3123.
3.Lewis, Heitkemper, “Medical Surgical Nursing”, 6 th Edition, Mosby
Publishers, Pg 1780-1792
4.P.K.Verma, “Mechanical Ventilation and Nutrition in Critically ill patients”, 1st
Edition, Elsevier publishers, Pg 345-350

NET REFERENCE:
www.en.wikipedia.org
www.emedicine.medscape.com
www.thoracic.org
www.chestnet.org
 TRACHEOSTOMY CARE
DEFINITION: Tracheostomy care include changing a tracheostomy inner tube,
cleaning tracheostomy site and changing dressing around the site
INDICATION
 Obstruction of the mouth or throat
 Breathing difficulty caused by edema ,injury or pulmonary conditions
 Airway reconstruction following tracheal or laryngeal surgery
 Airway protection from secretions or food because of swallowing problems
 Airway protection after head and neck surgery
 Long-term need for ventilator support
PURPOSE:
 To maintain patent airway
 To prevent infection at the tracheostomy site
 To promote comfort.
 To facilitate healing and prevent skin excoriation around the tracheostomy
site
 To promote comfort.
 To assess the condition of ostomy
EQUIPMENTS:
1. Tracheostomy care kit containing
a) Gallipots (3)
b) Sterile towel
c) Sterile nylon brush tube brush
d) Sterile gauze squares
c) Cotton T-tie or tracheostomy tie tapes
f) Sterile bowl for solution
2 A clean tray containing
a) Sterile suction catheter
b) Hydrogen peroxide
c) Normal saline
d) Sterile gloves-2 pairs
e) Clean scissor
f) Face mask and eye shield (optional)
g) K-basin
h) Water proof pad
3 Suction apparatus

Nursing action Rationale

1. Assess condition of stoma: (redness, Presence of any of these indicates

swelling, character of secretions, infection and culture test may be
presence of purulence or bleeding. warranted.
2. Examine neck for subcutaneous Indicates air leak into subcutaneous
emphysema evidenced by crepitus tissue.
around the ostomy site.

3. Explain procedure to the patient and

teach the means of communication Obtains cooperation from patient
such as eye blinking or raising a finger
to indicate pain or distress.

4. Assist patient to a fowler's position

and place waterproof pad on chest. Promote lung expansion.
Prevents soiling of linen.
5. Wash hands thoroughly.
6. Assemble equipments, Prevent cross- infection.
a) Open the sterile tracheostomy kit, Hydrogen peroxide and saline removes
pour hydrogen peroxide and sterile mucus and crust which promote
normal saline in separate gallipots bacterial growth.

b) Open other sterile supplies as

needed including sterile applicators, Enhance performance phase of
suction kit and tracheostomy care kit procedure
(dressing kit).

c) Put on face mask and eye shield

Protect the nurse.
7. Put sterile gloves. Place sterile towel
on patient chest. Maintain aseptic technique.

8. Suction the full length of

tracheostomy tube and pharynx Remove secretions.
thoroughly.

9. Rinse the suction catheter and

discard it.
10. Unlock the inner cannula ( if
present) and remove it by gently Hydrogen peroxide moisten and
pulling it towards you in line with its loosens dried secretions.
curvature. Place the inner cannula in
the bowel with hydrogen peroxide
solution ( Applicable for tubes having
inner and outer cannula).

11. Remove the soiled tracheostomy

dressing, discard the dressing and
gloves.

12. Put a second pair of sterile gloves.

13.Clean the flange of the tube using

sterile applicators or gauze moisten
Using the applicator or gauze only,
with hydrogen peroxide nad then with
avoids contaminating a clean area with
normal saline. Use one applicator once
a soiled gauze.
only.

14. Clean the stoma area with gauze

(make only a single sweep with each
gauze sponge before discarding)

Hydrogen peroxide helps to loosen the

Half strength hydrogen peroxide
dry the crusted secretions
(mixed with normal saline may be
used.)

Thoroughly cleanse the area using

gauze square moisten with sterile
normal saline.

Hydrogen peroxide is irritating to the

skin and inhibits healing if not removes
thoroughly.

15. Dry the stoma with dry sterile

gauze.

An infected wound may be cleaned

with gauze saturated with an antiseptic
solution, then dried.

A thin layer of antibiotic ointment may

be applied to the stoma with a cotton
swab.
16. Cleaning the inner cannula
Remove the inner cannula from the
soaking solution. Helps prevent wound infection
Clean the lumen and entire cannula
thoroughly using brush.
Rinse the cleaned cannula by rinsing it Thorough rinsing is important to
with sterile normal saline (agitating the remove hydrogen peroxide from inner
cannula in the container with normal cannula.
saline cleans it well).
Gently tap the cannula against the Removes solution adhering on the
inside of the sterile saline container cannula.
after rinsing.

17. Replace the inner cannula and

secure it in place
Insert the inner cannula by grasping
the outer flange and pushing it in the
direction of its curvature.
Lock the cannula in place by turning This secures the flange of the inner
the lock (if present) into position. cannula to the outer cannula.

18 . Apply sterile dressing

Open and refold a 4x4 gauze dressing
into a V shape and place it under the
flage of tracheostomy tube.
Do not cut gauze pieces.
Ensure that tracheostomy tube is
securely supported while applying
dressing. Avoid using cotton-filled 4×4 gauze.
cotton or gauze fibre can be aspirated
19. Change the tracheostomy ties by the patient potentially creating a
tracheal abscess.
a) Leave the soiled tape in place
until a new one is applied. Excessive movement of tracheostomy
b)Cut a piece of tape that is twice tube irritates the trachea.
the neck circumference plus 10cm.
cut the end of tape diagonally. Leaving a tape in place ensures that the
c)Apply a new tape tube will not be expelled if Patient
 Grasp slit of clea tape and pull it cough or moves.
through opening on one side of
the tracheostomy tube. This action provides a secure
attachment with knot.
 Pull the other end of tape
securely through the slit end of Diagonal cut facilitates insertion of
tracheostomy tube on the other tape into openings of neck plate.
side.

 Tie the tapes at the side of the

neck in a square knot. Prevents irritation and aids in rotation
of pressure site.
 Alternate knot from the side to
side each times tapes are
changed.
Excessive tightness compresses juggler
 Ties should be tight enough to veins, decreases blood circulation to
keep tube securely in the stoma, the skin and result in discomfort for
and loose enough to permit two patient
fingures to fit between the tape
 and neck.

d) Remove old tapes carefully.

20. Document all relevant information

in the chart
 Suctioning done
 Tracheostomy care carried out.
 Dressing change and
 Observations

NURSES RESPONSIBILITY
1.Tracheostomy dressing should be done every 8 hours or whenever dressing is
soiled
2.If disposable inner cannula is present, then replace the one that is inside with a
new one.
3.If only single lumen is present, clean the neck plate and tracheostomy site.
4.Emphasize the importance of handwashing before performing tracheostomy care.
5.proper way on how to remove, change, and replace the inner cannula.
6.Check and clean the tracheostomy stoma.
7.Assess for symptoms of infection .

BIBLIOGRAPHY
1)Theresamma. CP., 2006 “Fundamentals of Nursing Procedure manual for
General nursing & Midwifery Course”. 1st Edition, Jaypee Brothers .p:412-415
2)Nancy Sr., 2002, “Principles & Practice of Nursing & Nursing arts procedures”,

5th edition published by N.R. Publishers, House, Indore.p:132-140.

3)Sagunthala Sharma ‘Birpuri’ “Principles and Practice of Nursing” 1st

edition Printed at Lordson Publishers p. 294-295
4)Brunner & Siddarths, “Text book of Medical- surgical Nursing”- 12th
edition, volume2, published by Wolters Kluwer Page No: 648-651
5)Lewis, collier, Heitkemper, “Medical–surgical Nursing”, 4th Edition, Mosby
publication Page no: 603-610
NET REFERENCE
 https://www.upmc.com
 https://www.webmd.com