(2) After insertion of the outer cannula, the obturator is removed. The inner
cannula is inserted into the outer cannula and locked in place.
(3) Tracheostomy tubes may be metal or plastic. Plastic tubes that have an
inflatable cuff surrounding the outer cannula are the most commonly used. The cuff
helps to hold the tube in place, prevents aspiration of material into the lungs, and
prevents leaking of air around the sides of the tube.
(4) The tracheostomy tube is kept in place by means of cotton twill tape
inserted through the slotted flanges of the outer cannula and tied around the patient's
neck. A sterile dressing is placed around the tube to protect the stoma.
2-38. TRACHEOSTOMY NURSING CARE
a. Preparatory Nursing Measures. In addition to routine preparation of the
patient unit for postoperative care, the following measures should be planned in
(1) The patient will require constant attendance for at least the first 48
hours. The nursing personnel must remember two important things: the patient's life
depends upon a clear airway, and the patient will have a temporary loss of voice.
Therefore, the patient must be observed closely for airway patency and immediate
action taken when any adverse signs or symptoms are present. The patient will feel
anxious about his inability to communicate with his voice. Always have the call bell
available to the patient. Devise a temporary means of communication such as writing
notes or using flash cards so that the patient may communicate his needs to the nursing
(2) For the first few days postoperatively, the patient should be kept in a
room where the temperature and humidity can be maintained at optimum levels.
Increased temperature and humidity will help to reduce the tracheal irritation that results
when inspired air has bypassed the natural warming and moisturizing of the
(3) The patient's room should be supplied with a variety of equipment
necessary to the care of the patient. Such things include suction equipment, a spare
tracheostomy tube set, and sterile dressing material.
b. Postoperative Nursing Measures. In addition to routine postoperative
nursing care, the following nursing actions should be noted.
(1) Always apply basic principles of aseptic technique when caring for the
incision and the airway. When suctioning, use separate set-ups for pharyngeal and
(2) Constantly observe the patient for signs of respiratory obstruction such
as restlessness, cyanosis, increased pulse, or gurgling noises during respiration.