| Immediate post-tracheotomy care: |
- Personnel trained in management of tracheotomy.
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- Verification of the position (landmarks), with one end of the tracheotomy tube 4 to 6 cm from the carina in the tracheal lumen, securing of tube (skin sutures, ties, or Velcro), avoiding overly tight or loose fitting (movement limited to 1 finger width).
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- Check airway access: easy tracheal suction, monitoring of PetCO2, peak pressure (comparison with pre-tracheotomy values), absence of subcutaneous emphysema in the cervical or thoracic region, verification of hemodynamic stability and of the absence of heart rhythm disorders, check the position of the tube (chest radiograph).
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- Check the cuff pressure according to the guidelines applicable to airway access (P<3O cm H2O; 25 to 35 depending on the team).
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- Have in the room or close at hand equipment for reintubation and tracheotomy, in case of early accidental dislodgement.
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| Care on days 0 to 4: |
- Monitoring for hemorrhagic signs (apparent at scar site or on tracheal suction) every 3 hours postoperatively.
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- Examination of the scar and checking for signs of local infection.
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- Dressing changed with physiological saline 3 times every 24 hours (to avoid accumulation of secretions and moisture at the stoma).
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- Tracheal suction according to usual practice (defined frequency or on request), but measuring the maximum depth (down to the carina, up one centimeter and note the distance).
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- Airway humidification (heated humidifier, if necessary). Care of the inner cannula with cuffed tube.
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- Raise the head by 30°, in the median position, and be careful to preserve the axis of the head and trunk during mobilization and changes of position.
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- Check that the respirator tube is not pressing on the tracheotomy stoma.
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| Subsequent care: |
- Change the fixation every day or more often if oozing (hemorrhage or pus).
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- Check the scar every day.
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- Cleansing with isotonic saline.
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