day 3 resp

Tracheostomy Care in Hospital Settings

Post-Operative Care:

• Immediate care for patients with a tracheostomy involves monitoring for airway closure and ensuring the trach remains patent. Cuff pressure should be checked every shift (every 8 hours). Auscultation of lung sounds should be done before and after suctioning to monitor airway clearance.

Infection Control:

• Hospitals utilize sterile techniques to prevent nosocomial infections during tracheostomy care. Sterile gloves and fields are mandatory in a hospital setting. Home care may use clean techniques for cleaning the trach but suctioning must remain sterile. A trach should be cleaned at least every 24 hours or when soiled.

Suctioning Procedure:

• Suction is indicated when lung sounds are wet or when there is difficulty breathing. Preoxygenate the patient prior to suctioning to ensure they have enough oxygen. Suctioning should be for no longer than 10-12 seconds, and never exceed 15 seconds. Only suction on the way out, twisting the catheter to enhance clearance. Allow 30 seconds between suction attempts and monitor the patient’s oxygen levels continuously.

Equipment Usage:

• Suction Canisters: These should be enclosed in hospital settings for sterility.

• Oral versus Tracheostomy Suctioning: Oral suctioning does not need to be sterile, but tracheostomy suctioning must be to avoid introducing pathogens into the lungs.

• Suction Catheter Maintenance: Rinse with sterile saline or water before and after suctioning to maintain functionality.

Tracheostomy Size Management:

• Always keep an extra set of tubes at the bedside matching the patient’s current and one size smaller to ensure quick replacement if needed. Monitor for respiratory distress and ensure cleanliness around the stoma.

Cleaning Protocols:

• Clean the trach every 12 hours using precut gauze designed for tracheostomy care. Never cut gauze yourself to avoid string remnants entering the airway, which could lead to complications.

Oral Hygiene:

• Regular oral care should be maintained every 2 hours to prevent bacterial buildup, which can lead to complications.

Post-Operative Patient Education:

• Once stabilized at home, advise against submerging the stoma in water to prevent infections. Recommend covering the stoma in cold weather to protect the airway and prevent irritation.

Speech Communication Methods:

• Have devices and methods ready for patients who may have difficulty communicating post-tracheostomy. Some methods allow for esophageal speech training and rehabilitation to regain verbal communication.

Thoracentesis and Pulmonary Issues:

• Pleuritis vs. Pleural Effusion:

  • Pleuritis occurs due to inflammation of the pleura, the membrane surrounding the lungs, leading to sharp chest pain, especially with breathing or coughing, often associated with conditions like viral infections or pneumonia.

  • Pleural Effusion is the accumulation of excess fluid in the pleural space, which can compromise lung function. Diagnosis often requires imaging (like ultrasound or chest X-ray) to visualize fluid accumulation. Thoracentesis may be performed to relieve symptoms by draining the fluid.

Understanding Pulmonary Embolism (PE):

• Pathophysiology: Most commonly caused by a deep vein thrombosis (DVT) that dislodges and travels through the bloodstream to the pulmonary arteries, causing blockage.

• Symptoms: Include sudden onset of shortness of breath, rapid heart rate (tachycardia), chest pain (particularly sharp or stabbing), and a feeling of impending doom. Symptoms vary by the size and location of the embolism.

• Diagnostics: D-dimer testing helps rule out PE, while a CT angiography (CTA) can visualize clots in the pulmonary arteries.

• Treatment: Initial management involves intravenous (IV) heparin for anticoagulation, and in some cases, thrombolytic therapy is used to dissolve clots. Oxygen therapy is critical in managing hypoxemia, typically provided via a non-rebreather mask to ensure high concentration and low force to limit embolism risks.

Management of Deep Vein Thrombosis (DVT):

• Education on anticoagulation therapy, including warfarin, is crucial. Patients must be informed of dietary restrictions to maintain anticoagulant efficacy.

• Recognizing signs of DVT such as unilateral swelling, redness, warmth, and pain in the leg is critical due to its potential for complications like pulmonary embolism.

This document provides essential information regarding tracheostomy care, thoracentesis, and critical pulmonary conditions to enhance patient safety and care quality.