🩺 Chapter 41: Tracheostomy Care

Indications (UAO, prolonged ventilation) · Types of tubes (cuffed, uncuffed, fenestrated) · Immediate post-op care · Tube change (first at day 7) · Complications (early: bleeding, obstruction; late: granuloma, stenosis, innominate artery erosion) · DOPE mnemonic · Decannulation

🔍 Core Concepts: Tracheostomy Care

📌 Indications
Upper airway obstruction (subglottic stenosis, craniofacial syndromes, vocal cord paralysis). Long-term ventilation (neuromuscular, CLD, CHD). Pulmonary toileting.
🩺 Types of Tubes
Uncuffed (air leak, no aspiration risk). Cuffed (seals trachea, for ventilation, aspiration risk). Fenestrated (allows speech).
⚠️ DOPE Mnemonic (acute deterioration)
D: Displacement. O: Obstruction (most common). P: Pneumothorax. E: Equipment failure. Always assume obstruction first.
📋 Post-op Care
Stay sutures taped to chest. First tube change at day 7 (ENT). Humidification essential. Suction PRN (depth = length of tube).
⚡ Complications
Early: bleeding, pneumothorax, tube obstruction, displacement, surgical emphysema. Late: granuloma, tracheomalacia, suprastomal collapse, tracheo-innominate fistula (sentinel bleed).
🔁 Decannulation
When indication resolved. Bronchoscopy prior. Downsizing and capping trial. Must tolerate 24h occlusion before removal.

🩺 Stepwise Approach: Tracheostomy Care & Emergencies

1
Postoperative care (first 5-7 days)
Keep stay sutures taped to chest. Frequent suctioning. Humidification (heated or HME). Monitor for bleeding, subcutaneous emphysema. First tube change by ENT at day 7.
2
Routine daily care
Suction PRN (not on schedule). Stoma care (clean with NS, dry). Cuff pressure monitoring (≤20 mmHg). Secure tracheostomy ties (one finger loose).
3
Acute respiratory distress — DOPE mnemonic
D: Displacement (listen over stoma, EtCO2). O: Obstruction (pass suction catheter). P: Pneumothorax (breath sounds, CXR). E: Equipment failure (circuit disconnect, cuff leak).
4
Tube obstruction management
Attempt suction. If unable to pass catheter, deflate cuff, remove tube, cover stoma and ventilate via mouth/nose. Insert new tracheostomy tube with obturator. If fails, intubate orally.
5
Tube change technique
Prepare: fasting, sedation, backup tubes. Remove old tube, insert new tube with obturator in posterior then caudal direction. If resistance, try smaller size, use tube exchanger. Never force — risk of false passage.
6
Decannulation
Bronchoscopy to assess airway. Downsize tube, then cap. Patient must tolerate 24h occlusion with stable SpO2. Remove tube, cover stoma. Observe for 24h.