Wednesday, June 17, 2009

Tracheostomy Care and Suctioning

A link to a very remarkable video series crossed my path today: "Breath of Life: a caregiver's guide to pediatric tracheostomy care." When their infant daughter Elizabeth needed a tracheostomy due to severe laryngomalacia and tracheal stenosis, Matt and Melanie Dragovits used their professional backgrounds in video production and education, respectively, to produce this video which also features expert advice from respiratory therapist Ron Barrows. The caliber of tracheostomy care training Matt and Melanie received in the hospital after Elizabeth's surgery inspired this educational video, because they were left with the feeling that "more could have been done to help them take Elizabeth home." After watching this well-produced, professional video, I'm convinced that adult tracheostomy patients would also benefit greatly by watching this video.

Breath of Life is available free online, but can also be purchased as a DVD for those without internet access.

Among the patients assigned to my care in the hospital recently have been two adults with new tracheostomies. Both of these tracheostomies were intended for long-term (probably permanent) treatment of the underlying condition. In one case, a cancerous tumor was encroaching on the airway, while the other "trach" was necessary because severe injury damaged tissue in the upper airway.

Once upon a time . . . it was commonplace for an RN to provide comprehensive health teaching on a regular, shift-to-shift basis in the hospital . . . this education and evaluation of the patient's/family member's understanding was an emphatic component of the care provided to patients who were about to leave the hospital and embark on a life-altering course of complicated self-care . . . It was with shame and remorse that these recollections crossed my mind regarding these two patients--meanwhile, the obligations of the patient load as a whole whirled me away from contributing to reinforcement of the essential teaching points.

The consequences of poor tracheostomy care and suctioning can mean the difference between life and death. In Echo Heron's nursing anthology, Tending Lives, Diane C., a home health nurse, wrote a chilling account of poor trach care that haunts me to this day. A few years ago while working in an outpatient care center, a foster mother brought her toddler with a trach in to provide a mucus sample to determine the nature of the child's chronic lung infections. I was glad that I decided to observe the mother suctioning the trach to obtain the specimen. Her technique was so utterly wrong that she grossly contamintated the child's lungs with each suctioning that she'd performed during the months that the child was in her care. I remember literally feeling faint with the shock of what I was seeing. This foster mother meant no harm--but she was truly misinformed to a degree that could have certainly resulted in fatal harm to the child had it continued.

Most of us are visual learners who retain new information best when we can watch a demonstration--often more than one time. As inhabitants of the modern Western hemisphere, we've been influenced by many, many years of television viewing which have reinforced our visual learning preferences. It's also possible to find YouTube videos about tracheostomy care. Granted, they are not the same quality as professionally produced videos, but these amateur videos can definitely provide some helpful, additional visual images of trach care.

Once we have the visual image of the procedure clear in our mind, it's much easier to process the excellent written instruction instructions provided by Cincinnati Children's Tracheotomy Care Handbook and at (These are just two of the many excellent resources for trach information that I selected based on my online trach patient information search.)

It's imperative that you follow the advice of your physician, home health nurse and respiratory therapist and immediately consult them with any questions or problems about your loved ones tracheostomy.

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