Watch for the patency of the tracheostomy tube and maintain an open airway.
>The patient should not be alone for the first 24 to 48 hours.
>Remove be secretions that are collected in the tracheobronchial tree.
>Suction the trachea every 30 minutes on the first day.
>Observe Patient should be observed for the indications of respiratory difficulty such as noisy and labored breathing, restlessness, pallor, cyanosis, intercostal and sub sternal retraction etc.
>Plastic bags, papers, clothes etc., should not be left near children who had undergone tracheostomy else they may pull them ever the tracheostomy opening and obstruct the airway.
1. Keep following instruments ready:
>A tracheal dilator- to maintain an open airway till the tracheostomy tube is introduced.
>A pair of scissors to cut the tapes if necessary.
>An extra tracheostomy tube tied with tapes A and with obturator for replacement of the tube that is expelled.
>Double book retractor-to trace the tracheal opening.
>The obturator of the tube currently in use
>A small bowl to take cleaning lotions.
>Cleaning solutions, dressing materials etc
2. Additional articles may be kept ready at all times to meet with emergency:
>Suction apparatus with sterile suction tubes a sterile bowl with sterile water.
> Self inflating bag (Ambu bag).
> Oxygen apparatus.
>Respirator.
>Humidifier (A kettle with boiling water can replace when humidifier is not available).
>Maintain a Fowler's position to aid in the breathing.
3. Observe the patient constantly and detect the complications such as:
>Tube diplacement
>Indications of shock, hemorrhage, hypoxia, respiratory insufficiency.
>Respiratory obstruction, noisy breathing.
>Excessive restlessness.
>Uneven movements of the two sides of the chest.
>Retraction of tissues over the supraclavicular, suprasternal, intercostal and epigastric regions.
>Frequent tendency to cough.
>Prevent infection of the respiratory tract.
>Practice asepsis
>Ensure Warnoch Fibration and humidification of the inspired air.
>A few layers of sterile wet gauze over the tracheostomy will help to filter and humidify the air.
>Care should be taken to change the gauze as necessary.
>Keep the room warm. Allowing a kettle of water boiling in the patient's room will help to humidify the air. Steam inhalations are given at least twice a day. When oxygen is administered, it should be humify.
>Maintain an adequate fluid intake to keep the mass membranes of the respiratory tract moist.
>If oral fluid intake is not adequate, intravenous fluid may be administered.
>Maintain flood and electrolyte balance. Keep an accurate in take and output chart.
>Medications that may depress the respiratory centre should not be used as narcotics and sedatives.
