Tracheostomy Tube Change

Excerpt

Tracheostomy is a procedure where an artificial airway is established surgically or percutaneously in the cervical trachea. The term “tracheostomy” has evolved to refer to both the procedure as well as the clinical condition of having a tracheostomy tube. The first documented tracheostomy (or tracheotomy) was performed in the 15th century.

In 1976, Dr. Frost wrote an interesting historical account on the development of tracheostomy through the ages, covering five main stages filled with drama and fear that eventually culminated in a routinely performed procedure in modern medicine. In the early twentieth century, Chevalier Q. Jackson developed and helped to standardize the procedure in addition to resolving the many difficulties and debates surrounding the procedure. Later in the same century, however, it became apparent that oral or nasal intubation could be performed safer and quicker with lower complication rates. As a consequence, modern practices advocate justification, rationalization, and standardized continuous care of patients with tracheostomy.

Over 83,000 tracheostomies were placed in the United States in 1999. Furthermore, Mehta et al. found a substantial increase in tracheostomy use between 1993 and 2012 in the United States. In England (United Kingdom), according to The National Tracheostomy Safety Project (NSTP) estimates, up to 15000 percutaneous tracheostomies are performed in the intensive care unit and further 5000 surgical tracheostomies in head and neck surgery.

With the increasing number of patients with tracheostomy, safe caring requires knowledge and competencies in dealing with routine care, weaning, decannulation, as well as tracheostomy-related emergencies. Tracheostomy tube change is part of routine care, but complications may occur more frequently in the absence of competence and a robust system of tracheostomy care.

This article aims to provide a basic understanding of the tracheostomy procedure and its relevant anatomy, thereby explaining the principles behind tracheostomy care with a primary focus on changing the tracheostomy tube.