Tracheostomy is an opening that is made through the skin in the front of the neck into the trachea windpipe (Tortora and Grabowski, 2001). A tracheostomy tube is inserted to bypass a trachea that is blocked by welling or blood in order to assist with breathing, therefore the tube is removed once regular breathing is possible again. But in other cases, a person may need a permanent tracheostomy tube to help breathing at night due to permanent damage or loss of function around the larynx or swallowing area (Murrary and Frenk, 2010).
According to the National Tarcheostomy Safety Project (2013), over 5,000 procedures performed yearly in England with an estimated around 10 to 15 thousand tracheotomies are performed each year in England’s critical care units. The affected groups include those with chronic respiratory, neurological problems or trauma related (NTSP, 2013).
According to Serra (2000), tracheostomy care is aimed to maintain airway and oxygen to patients. To effectively care for a patient with tracheostomy, staffs are require to have the appropriate skills of respiratory assessment, an in-depth understanding of humidification, knowing when and how to suction, stoma care and management of tube blockage (Barnett, 2007). The National Institution of Health and Clinical Excellence (2012), supports that, staffs need to be ensure they are knowledgeable and informed to provide safe and effective care for patients. According to Patel and Matta (2004), Tracheal suctioning and stoma care must be performed using sterile equipment, however, Russel (2009) highlights that, tracheal suctioning should not be done routinely but only after the staffs has identified the need for suctioning through proper patient assessment. The indications for suctioning increases coughing, rise in the airway pressure, suspected aspiration, reduced airflow and deteriorate peripheral oxygen saturation (Regan and Dallachiesa, 2009). The Department of Health (2011) supports Patel and Matta (2004) that, sterile procedures minimized the risk of infections. Educating patients and encouraging oral communication is important to lessen the adverse psychological effect of isolation by helping the patients to understand the necessity for isolation therefore giving them the opportunity to cope better (Morgan et al., 2009). Russell (2009) states that, nurses need to encourage both the patient and family to use other forms of communication to achieve the ultimate goal to restore the patient ability to communicate consistently and effectively. A study conducted by Day (2002) stated that, between seven to eight million people in the United Kingdom are functionally illiterate, therefore, nurses need to ascertain the patients literacy level before go ahead with any method. Day (2000), added on that, latter enable patients to erase previous conversation which enables confidentially to be maintained. This is supported in line with the Nursing and Midwifery Council (NMC) (2008) that, confidentiality needs to be maintained at all time. According to Clotworthy et al (2006), extra attention should be given to non verbal communication such as facial expression, hand or body position and movement including lip reading. Serra (2000) supported it that, patient should be encouraged to exaggerate lip movement and use short but complete sentences in order to make the message clear. Therefore, whichever communication method is utilized by the patient, it is essential that all recipients such as friends, relatives and staffs allow the patient time to express themselves (Woodrow, 2002).
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Tracheal suction is an essential component of managing secretions, maintaining respiratory function and a patent airway (Higgins, 2009). Ireton (2007) highlighted that, the presence of prominent audible secretions, visble secretion, decreased oxygenation or diminished breath sounds during assessment would indicate a need for suctioning. Most contraindications are relative to the patient’s risk of developing adverse reactions or worsening clinical condition as a result of the procedure. Suctioning can cause distress, is uncomfortable and is associated with airway changes and should therefore only be performed when indicated and not at fixed intervals. Frequency should be determined on an individual patient basis and suctioning should aim to clear airway secretions where the patient is not able to, ensuring airway patency and patient safety at all time. Suctioning may not be as effective if the secretions become too tenacious or dry. Anecdotal evidence through practice suggests that, frequent 0.9% sterile sodium chloride or acetylcysteine nebulizers may assist in loosening dry and thick secretions (Fraise and Bradley, 2009). Hough (2001), states that incorrect choice of catheter size can cause mucosal damage if the diameter of the suction catheter should exceed one half of the internal diameter of the tracheostomy tube. Hence choosing to not suction in order to avoid a potential side effect may sometimes can be more harmful to the patient. However, despite its necessity, suction may be painful and distressing to the patient and can also be complicated by slow heart beat (bradycardia), low blood oxygen (hypoxaemia) and cardiovascular compromise, bleeding and the introduction of infection (ICS, 2008). Universal precautions must be use at all times when suctioning as stated by the DH (2007). According to NHSMA (2005), both staff and patient are at risk of infection when suctioning is being performed and in order to minimize infection, examination gloves should be worn and an aseptic technique should be used. Department of Health (2007) supports that, hands with an alcohol rub before and after suctioning procedure is vital to decontaminate hands.
The realization of this assignment was very fruitful for academic training. Nursing patients with a trachostomy can be very challenging. Since such patients are becoming more common with such procedures, nurses must ensure that knowledge and skills are maintained both from a theoretical and practical perspectives. Above all, nurses must care for patients with tracheostomies based on the prevention of infection to the extent that its prevention is a primary goal of patient comfort.
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