When should you flush a cannula
Tracheostoma care - you have to pay attention to this
More and more people have a tracheostomy - that is why its care is becoming an increasingly present part of the range of tasks of outpatient and inpatient care services.
In this article you will learn how to properly care for a tracheostomy.
This is what tracheostoma care is used for
On the one hand, caring for the tracheostoma should prevent skin damage and wound infections and keep the skin as free from irritation as possible.
In addition, damage to the skin and infections that have already occurred should be treated and cured.
It is also important to avoid damage caused by pressure under the needle shield or in the area of the retaining strap.
There is disagreement about how often a tracheostomy needs to be cared for and how sterile it needs to be.
Basically, however, every person is different and must therefore also be treated based on their individual situation.
And that also includes taking care of the tracheostoma.
Treatment of a tracheostoma
A tracheostoma is an aseptic wound. This means that it is free from germ colonization, as it was created under sterile working conditions and has smooth wound edges.
Accordingly, it must also be treated under aseptic conditions. This includes the following aspects:
- Hand disinfection
- Use sterile tools and materials
- Cleansing the wound from the inside out
The risk of pneumonia is high because germs can get into the lungs very quickly through the tracheostoma.
A tracheostomy must be bandaged 1-3 times a day. This happens for several reasons:
- Skin condition inspection
- Change of soaked compresses (especially in the early stages and with strong secretion)
- Inspect and avoid skin irritation and complications
The cannula retaining strap, on the other hand, only needs to be replaced when soiling becomes visible, i.e. not every day.
This is needed for tracheostoma care
In general, the following materials are needed to treat the tracheostoma:
- separate waste bin
- Hand disinfectant
- Gloves (non-sterile as well as sterile)
- Sterile swabs, compresses and cotton swabs
- Tracheal compress (must be chosen individually)
- Saline solution or ostomy care oil / towels
In addition, there are also special materials that are required in special cases.
If the tracheostomy tube has a Cuff a cuff pressure meter is also required.
A cuff closes the windpipe and compensates for pressure fluctuations in it. This serves to avoid injury and the risk of secretions getting into the deeper airways. However, these secretions must be suctioned off.
If Signs of inflammation show or there are injuries, antiseptic ointments or mucous membrane disinfectants such as Octenisept® should be used. However, such ointments must be specially prescribed by a doctor.
Provided Skin irritation occur, these must be countered with a wound irrigation solution. The exposure times depend on the respective product.
In this case, an acrylate film should also be used to protect the skin, as well as a wound and healing ointment.
If the skin around the tracheostoma is extremely damaged, the use of a hydrocolloid plate is also recommended.
If there are no such complications on the wound, the area around the tracheostoma can also be cleaned with pH-neutral agents and water at a pleasant temperature.
Neither Penaten cream nor zinc paste are suitable for treating the tracheostoma, as removing residues also irritates the skin and the agents also close the pores.
Types of tracheal compresses
Tracheal compresses serve the following purposes:
- Padding of the cannula shield
- Absorption of secretions
There are unslit and slit tracheal compresses. The latter have a slot so that they can be changed without having to remove the tracheostomy tube.
Both types are lint-free and also retain their shape when they get wet.
Under no circumstances use a conventional gauze compress with an incision as a tracheal compress. Individual threads could come loose and enter the tracheostoma, causing major complications.
Some tracheal compresses also have a so-called zip slit, which prevents the compress from slipping down. This can be particularly important for mobile people.
There are several different tracheal compresses that have different uses.
Polyurethane foam compresses
The polyurethane foam from which these tracheal compresses are made can absorb liquids extremely quickly. This avoids sticking to the tracheostoma. They also cushion very well.
Since these compresses only have one layer, they are very thin and therefore very comfortable to wear. However, they naturally also absorb less tracheal secretion than other compresses.
Tracheal compresses with aluminum vapor deposition
The aluminum vaporization of the compresses prevents them from sticking with blood and tracheal secretions.
A disadvantage of this compression, however, is that it can only absorb a small amount of secretion that arises in the vicinity of the stoma (parastomal secretion).
The compress is applied with the silver side towards the skin.
Since these compresses have 2-3 layers, they naturally also absorb much more secretion than, for example, single-layer compresses. Often the top layer is also impermeable to water, which protects clothing.
Which compress you use depends on how much secretion the patient makes. The frequency with which the compress has to be changed also depends on this.
This is how a compress is applied
Since the tracheostoma is an aseptic wound, dressings are changed aseptically.
It is essential to ensure that no liquid can get into the tracheostoma. The penetration of liquid would trigger an aspiration.
Before applying the compress, an antiseptic ointment, a wound and healing ointment or a skin protection product must be used if necessary.
Use the correct compress side
If you apply the wrong side of the compress to the skin, this can lead to fluid build-up because not enough secretion can be absorbed. The results are often:
- Irritated areas
- Excessive formation of wound tissue
This means that it is imperative to use the correct side of the compress.
Which is the right one now?
Most compresses have a layer of polyethylene mesh on the side that is placed on the skin.
This layer is shiny, which makes it relatively easy to recognize. The polyethylene net prevents the compress from sticking to the skin.
Other manufacturers use blue threads to mark the side that must face the skin.
If you are not sure which side of the compression should be facing the skin, it is best to read the package insert carefully.
Apart from that, there is also the water test: drip some water on the compress. When the water is absorbed, it is the skin-facing side. If it rolls off, then it doesn't.
However, you should no longer apply this compress to the patient.
Sebastian Kruschwitz is Head of Wound Management at the ZBI Group. In addition, he is a nursing therapist for wound ICW, deputy case manager and specialist nurse for out-of-hospital ventilation.
Apart from that, he is a member of our KAI scientific advisory board and above all responsible for the organization of the wound symposium.
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