Timby's MedSurg 14e

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UNIT 5 Caring for Clients With Respiratory Disorders

and places a gauze dressing under the tube to absorb secre tions. The hospital gown and bed linens must never cover the opening of the tracheostomy tube. Nursing Care Plan 20-1 describes additional care, and Evidence-Based Practice 20-1 describes research on tracheostomy safety considerations. ENDOTRACHEAL INTUBATION AND MECHANICAL VENTILATION An endotracheal tube (Fig. 20-7) is inserted through the mouth or the nose into the trachea to provide a patent airway for clients who cannot maintain an adequate airway on their own. Examples include those with respiratory difficulty, co matose clients, those undergoing general anesthesia, and cli ents with extensive edema of upper airway passages. General Considerations An endotracheal tube can remain in place for up to 2 weeks. The cuff is inflated to provide a tight seal. The endotracheal tube is attached to a ventilator for control of respirations and Reference Mc Mahon, A., Griffin, S., Gorman, E., Lennon, A., Kielthy, S., Flannery, A., Sam Cherian, B., Josy, M., & Marsh, B. (2023). Patient-centered outcomes following tracheostomy in critical care. Journal of Intensive Care Medicine , 38(8), 727–736. https://doi.org/10.1177/08850666231160669 Evidence-Based Practice 20-1 Percutaneous Tracheostomies Clinical Question Does the timing of placing and weaning tracheostomies play a role in client outcomes? Evidence Tracheostomies occur as a common treatment in proce dures that take place in the head and neck area, many times placed during emergency treatment. In the past, outcomes for clients with tracheostomies were meas ured by the quality of life after the tracheostomy and cli ent mortality rates. New evidence shows that reviewing the clients: communication, oral intake, and mobilization, during their hospitalization can greatly affect the short- and long-term client outcomes. In this study over 2 years with over 300 clients, it was noted that the quicker clients were weaned from the ventilators and tracheostomies, the better the client outcomes. Two-thirds of the clients had better outcomes with communication, oral intake, and mobilization and were able to be discharged home sooner (McMahon et al., 2023). Nursing Implications Nurses may not have clients frequently with tracheos tomies. However, understanding the importance role of client outcomes regarding earlier weaning from the tra cheostomy can determine how the client will progress in their hospitalization and illness. Clients who had trache otomies weaned earlier had improved client outcomes. Nurse that cares for clients with tracheostomies should, along with the provider, monitor the client’s progress and assess the continued need for the tracheostomy.

NURSING GUIDELINES 20-2

Suctioning the Client With aTracheostomy • Use sterile equipment (e.g., gloves, suction catheter, normal saline) and aseptic technique for tracheal suctioning. • Place client in Fowler position. Preoxygenate client for at least 1 to 2 minutes. Check that suction pressure is at a low setting. • Open the suction kit, don gloves, lubricate a sterile 10- to 14-French disposable catheter with sterile saline, and insert it into the lumen of the tube. • Do not apply suction while the catheter is inserted down the trachea because this irritates the lining of the trachea. • Begin intermittent suctioning while slowly withdrawing and rotating the catheter. Do not suction for more than 10 sec onds at a time. • Allow client to rest and deep breathe before repeating if more suctioning is necessary. • Discard the suction catheter after use. ProvidingTracheostomy Care • Maintain aseptic technique by washing hands before, dur ing, and after the procedure. • Position client in a supine or low Fowler position. • Using a clean glove, remove the soiled stomal dressing and discard it, glove and all, in an appropriate receptacle. • Open the tracheostomy kit without contaminating the contents. Don sterile gloves—keep the dominant hand sterile. Pour hydrogen peroxide and normal saline into respective containers. • Unlock the inner cannula by turning it counterclockwise. Remove it and place in hydrogen peroxide. Clean the inside and outside of the cannula with pipe cleaners. • Rinse the cleaned cannula with normal saline. Tap the can nula and wipe the excess solution with sterile gauze. • Replace the inner cannula and turn it clockwise within the outer cannula. • Clean around the stoma with an applicator moistened with normal saline. • Place a sterile dressing around the tracheostomy tube. Change the tracheostomy ties by placing the new ones on first and removing the soiled ones last. Tie the new ends se curely, but not tightly, at the side of the neck. NURSING GUIDELINES 20-3

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Securing a tracheostomy dressing.