Skill 46[1]..Tracheostomy Monitoring.pdf

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SKILL 46

Tracheostomy Monitoring

EQUIPMENT

NOTE: Equipment is kept at bedside or in room when

client has a tracheostomy.

way, level of consciousness every 2 hours (more fre-

quent as determined by physician’s order or assess-

ment). Include respiratory rate, work of breathing

(retractions, flaring, grunting), breath sounds, chest

symmetry, color, oxygen saturation. Monitor cardiorespi-

ratory monitor and pulse oximeter.

2. Position child to prevent airway occlusion and secretion

drainage.

3. Maintain pulmonary toilet, e.g., cough, deep breath,

incentive spirometer, activity.

4. Assess viscosity, color, odor, and amount of secretions

when suctioned.

5. Assess hydration status in relation to viscosity of secre-

tions. Note heated humidity, medications, skin turgor,

mucous membranes, intake and output.

6. Provide oral care bid or more frequently as needed.

7. Assess means and effectiveness of child’s ability to com-

municate daily needs (both acutely and long term).

Provide alternative methods as needed, e.g., tongue

clicking, tapping on bed, paper and pencil. Involve

speech therapist.

8. Promote ongoing nutrition needs, calorie counts as

needed, plan intake with respect to possible changes in

smell, taste, and swallowing ability.

9. Assess ongoing psychosocial needs of child and family

coping with tracheostomy placement (acute and long

term).

10. Assess developmental needs.

11. Discuss with family discharge needs regarding equip-

ment procurement for long-term tracheostomy plan.

Appropriately sized resuscitation equipment (mask, valve,

bag)

Oxygen and humidity delivery source

Suction source, canister, and connecting tubing

Gloves, mask, goggles, gown (as appropriate)

Spare tracheostomy tubes (see note below)

Spare tracheostomy tube holder

Appropriately sized suction catheter pack (#8 to #10 French

for children, #5 to #8 French for infants)

Oxygen flow meter and blender

Pulse oximeter

Cardiorespiratory monitor

Bandage scissors and small hemostats

Pre-slit Sof-Wick dressing, cotton-tipped applicators

Unit dose normal saline

Half-strength (1.5%) peroxide, sterile water/normal saline

Antibiotic ointment if ordered

NOTE: For a new tracheostomy, spare tracheostomy

tubes should include same size and 1 / 2 size smaller. For

an established tracheostomy, spare tracheostomy tubes

should be same size.

SAFETY

1. Infants and children unable to notify others of distress

must be observed at all times.

2. The child, when transported outside of the client room,

must be accompanied by trained personnel.

3. Initiate “Code Blue” and provide resuscitation if child

experiences respiratory failure.

4. The following items must accompany the child leaving

the room: spare tracheostomy tubes, self-inflating resus-

citation bag, mask, suction catheter, suction connecting

tubing, normal saline, stethoscope, Sof-Wicks, tra-

cheostomy tube holder, water-soluble jelly, bandage scis-

sors, gloves, portable suction (if needed).

5. Prevent potential aspiration by maintaining environment

free of safety hazards.

6. Be alert to complications including obstruction, hemor-

rhage, subcutaneous emphysema, tube dislodgement,

periostomal irritation, redness, or breakdown.

DOCUMENTATION

1. Assessment every 2 hours (more frequently if neces-

sary), respiratory rate, work of breathing (retractions,

flaring, grunting), breath sounds, chest symmetry, color,

oxygen saturation, patency of airway, tube placement,

tube size, security of tracheostomy, level of conscious-

ness.

2. Appearance of stoma and neck every shift and as needed

(prn).

3. Frequency of suctioning, appearance and quantity of

secretions, and tolerance of procedures as performed.

4. Date of last tracheostomy tube change.

5. Child and caregiver education.

PROCEDURE

1. Assess patency of airway, tube placement, tube size,

security of tracheostomy, proper humidification to air-

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