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Welcome to the Nesting protocol video instructions. In this video you will hear basic beginner’s information about the management of your loved one should you choose to proceed with a Tracheostomy tube and Feeding tube also known as a “PEG “tube.
Please understand you will also receive hands on instructions and written material to guide you thru this process. If you have any questions please write them down and discuss them with your primary nurse, ICU physician or case manager.
Insertion of a tracheostomy tube is a surgical procedure that can be very intimidating to family members and caregivers. We understand that making this decision for your loved one is not easy. This is why we have created this video to guide and explain some of the tasks you and another caregiver will need to perform on a routine bases, both day and night.
The tracheostomy tube will connect to a machine (also known as a ventilator) that helps your loved one breath and provides the necessary pulmonary support. The ventilator can be present for days, weeks, months or sometimes years.
Caring for a loved one on a ventilator is a full-time task, that requires care 24 hours a day, 7 days a week. This requires a team of people to do this successfully. Just as there is multiple caregivers in a hospital, such as nurses, doctors, respiratory therapist, it is essential that you as the care giver have a team of at least 1 person or additional helpers to assist you in this home care journey.
A tracheostomy is a surgery that creates an opening through the front of your neck into the trachea (windpipe). A tracheostomy tube is usually put through this hole into the windpipe. However, the word tracheostomy is commonly used to describe both the surgery and/or the tube. Tracheostomy tubes allow people who cannot breathe on their own to be connected to a ventilator (breathing machine) or receive additional oxygen. It also allows air to bypass an injury or blockage in the upper part of the windpipe to reach the lungs
The outer cannula is the main body of the tube. It is held in place with a Velcro strap, which wraps around the patient’s neck. The trach tube pictured here has a “cuff”. A cuff is a balloon attached around the outside of the tube. When inflated thru the pilot port valve, the cuff seals against the inside walls of the airway.
A cuff is necessary when a patient is on a mechanical ventilator also known as the breathing machine)because it ensures that air is entering the lungs and not escaping through the nose and mouth.
The cuff also prevents aspiration of saliva or if the patient is at the point where they can eat then it prevents aspiration of fluids or food .
Another important part of the tracheostomy tubes is the Falange. The Falange is the plate that will rest against the skin of the patient when in place.
Inner Cannula: The inner cannula fits inside the trach tube and acts as a liner. This inner cannula is most common disposable and it should be changed every 12-24 hours or as the patient needs it. This will helps prevent the build-up of mucus inside the trach tube. The inner cannula locks into place to prevent accidental removal. There are also none disposable inner cannulas and those will need to be cleansed with normal saline and a special brush pictured here.
Obturator: The obturator is used when placing a trach tube or during trach changes. It is inserted into the main body of the tracheostomy tube and acts as a guide to help place the trach tube into the airway. Its smooth, rounded tip protects the inside of the airway from damage during insertion. The obturator is only used when inserting a tracheostomy tube. It must be removed as soon as the trach tube has been placed.
This is an example of the supplies you may be provided to perform Tracheostomy Care . One bottle of sterile water, A tracheostomy tube neck securing device. The Small brush would ONLY need to be used to clean out NON disposable inner cannulas.
A Suction Cather.
Split or fenestrated gauze. Please do not cut any piece of gauze as the gauze fibers can be accidentally breathed in by the patient. Cleaning gauze for cleaning around the site any other soiled part of the tracheostomy tube.
Next you will see a brief video on how to perform this task.
Whenever you are preparing to perform tracheostomy care it is important to have certain items ready.
An ambu bag in case of an emergency
Clean gauze
Sterile bottle water to clean site
Suction catheter
Couple Qtips
A Suction kit
If your loved one is NOT breathing, you must provide rescue breathing and CPR. It is recommended that you take a first aid and CPR classes. The following video will demonstrate rescue breathing for your loved one in case of an emergency.
Ensure you cover the mouth and nose of your loved one when providing rescue breaths.
Along with a tracheostomy tube your doctor will also discuss the placement of a feeding tube for your loved one. A PEG tube or feeding tube is a way to provide food, liquids and medications (when needed) directly into the stomach of your loved one. Your hospital nurse will demonstrate how to feed your loved one via the gastric tube. You will learn how to feed your loved one along with repositioning in the bed and mobility exercises, and all items related to his breathing tube.
As you are getting ready to go home with your loved one there will be additional information provided such as when to call 911. You will also need to notifying your local utility company, Emergency medical service (EMS and the Fire Department) in order to make sure all is in order in your home prior to your loved ones arrival.
There will be home environment changes that need to be address prior to going home. Things such as NO INDOOR smoking, the location of your loved one’s bed within the home. Ambulance access and door access to any large pieces of equipment. This will be discussed with your case manager.
Remember any questions regarding this process should be addressed prior to you and your support system leaving the hospital.