Editing Tracheostomy (section)

== '''Tracheostomy management''' ==

* Humidification and regular suction
* Apply CCrISP algorithm if problems arise
* Don't change too soon - 3/7 post open, 1/52 post perc to ensure tract forms
* Should have inner canulae if on wards due to risk of blockage
* Routine changes
** Every 30-90 days
** 7-30 days post initial insertion
* Decannulation
** Indications
*** No upper airway obstruction
*** Ability to clear secretions that are neither too copious nor too thick
*** Presence of an effective cough
** Weaning
*** Progressive decrease in size of tracheostomy tube
*** Progressive capping trials until tolerated for 12, 24 or 48 hours
** Usual progression:
*** De-shield
*** Cuff down trial
*** Cuff down
*** Swallowing assessment
*** Consider decannulation
* Procedure
** Equipment
***
** Monitoring
** Supplemental oxygen via tracheostomy mask
** Neck extended slightly
** Suction
** Deflate cuff
** Remove tube
** Dress and occlude stoma
** Observe for signs of respiratory distress





Cuff: essential to provide PPV, also reduces risk of aspiration. Some traches don't have a cuff.

* Deflating cuff allows patient to breathe through mouth, and phonate (when they occlude the trache tube)

Inner cannula: allows the tube to be changed and cleaned without having to take the whole thing out

* However, it decreases the effective diameter of the tube, so they get more resistance to airflow.