Question

You have a patient allocated to you who have returned from ICU with a tracheostomy insitu as well as an underwater seal drain after being ventilated for three weeks postoperatively.

You must clean the tracheostomy and care for the UWCD. Write down the equipment required as well as the steps you will follow to perform the procedure to clean the tracheostomy and care for the UWCD.

Answer 1

*****Tracheostomy care*****

This is done to keep your teach tube clean. This care will prevent vloggedtube and prevention of infection. Tracheostomy care includes suctioning and cleaning of its parts also skin around this tube.

Parts of Tracheostomy tube

1. An outer canula
2. Flanges
3. Teach ties
4. A cuff.
5. An inner canula
6. An obturator
7. A speaking valve.

Always keep one spare of Tracheostomy with you before cleaning. instruments needed is

• Tracheostomy with same size ,other 1smaller size
• Obturator for each track tube and an empty syringe
• One set of Tracheostomy tie.
• Portable suction machine.
• Suction catheters
• Sterile saline and lubricant
• Rescue breathing bag and mask.

Procedure

Explain to the patient.

Wash your hands.

use clean or sterile equipment to clean.

Can use Tracheostomy cover, if it used above the opening of Tracheostomy, remove this. It helps to prevent dirt to airway. Take out inner canula ,clean it with soap and water ,use hydrogen peroxide .clean it well ,remove all mucus. Then dry it and replace it. clean the flanges.if the canula is too dirty can use a new canula . change the wet or dirty tie and tie the trach tube properly.

Clean stoma area well check here for any sinns of infection.

Clean the patient mouth. If he can advise them to brush teeth twice a day .it help to prevent infection .

Educate deep breath exercise. Helps to prevent risk of lung infection. Always try to do it before suctioning also.

Suctioning Do suction if it is needed.

Get the suction machine ready .

Wash your hands

Make the patient to comfortable position. Keep a pillow under the neck helps to open airway.

Insert catheter into the tube .do suction .at least 15 seconds will take to out the catheter.

If needed do it once more.

Suction the stoma if any leak of mucus or bleed.

Dispose the catheter ,if it reusable clean and re use it.

Remove gloves and wash hands

Replace all equipments.

****CAREVOF DRAIN****

under water chest drainage is the safest method is used to drain pleural collections including blood ,air,pus, and lymphatic fluid.

1. Never lift drain above chest level.should be under patients chest level to facilitate drainage.
2. Tubing should not have any kinks or obstructions that may inhibit drainage.
3. Ensure all connection between chest tubes and drainage unit are tight and secure.

Things needed....

New drain

Dressing pack

Gloves

Connector

Cable ties.

Procedure

Wash hands.use personal protective equipments.

if it is infected site need to change dressing on daily basis.avoid unnecessary changes if it is no needed .it helps to prevent accidental removal .

(Change drain chamber.when it is needed or as per order.use new drain as per manufacturer directions.) Ensure the drain clamped to Prevent air being suck end back into chest.disconnect old chamber by holding down .insert the new tubing into chamber until here it click.unclamp the chest drain.check drain back on suction.place old chamber in to yellow bin after measured the fluids. Then remove glove and wash hands. Replace all equipment used..

Both Tracheostomy and drain care is important to prevent infections and further risk of complications.