What equipment is needed at the bedside for a patient with a tracheostomy?

According to respiratory care experts, maintaining a ready supply of the correct tools is a critical aspect of patient safety. Understanding what equipment is needed at the bedside for a patient with a tracheostomy is the first and most vital step for caregivers in both hospital and home settings.

Quick Summary

Essential bedside equipment for a patient with a tracheostomy includes emergency items like spare tubes (same size and one size smaller), a resuscitation bag, and scissors, along with daily care supplies such as a suction machine, catheters, saline, and proper humidification devices.

Key Points

• Emergency Preparedness: Always have spare tracheostomy tubes (same size and one size smaller) and a manual resuscitation bag readily available at the bedside.

• Daily Maintenance: Keep a suction machine, appropriate catheters, saline, and a trach care kit organized and accessible for regular cleaning and airway management.

• Essential Humidification: Use either a Heat Moisture Exchanger (HME) or a nebulizer to warm and moisturize the air, preventing thick secretions and mucous plugs.

• Stoma Site Care: Maintain a supply of sterile gloves, gauze dressings, and cleaning solutions to keep the skin around the tracheostomy site clean and free of infection.

• Safety and Organization: Ensure the bedside area is clear, well-lit, and equipped with blunt-ended scissors and a syringe for emergencies, with all equipment checked regularly.

• Infection Control: Always use sterile supplies and follow proper hand hygiene protocols to minimize the risk of infection around the tracheostomy site.

• Proper Securing: Use appropriate tracheostomy ties or holders, checking for a secure but not too tight fit, with blunt-ended scissors kept nearby for quick removal if needed.

The Essential Tracheostomy Emergency Kit

For any patient with a tracheostomy, immediate access to an emergency kit is non-negotiable. This kit must be prominently displayed and easily accessible to all caregivers. A sudden dislodgement or blockage of the tracheostomy tube can be life-threatening, making these items vital for a rapid and effective response.

Critical Emergency Items

• Spare Tracheostomy Tubes: Always keep at least two spare tubes readily available. One should be the exact same size as the patient's current tube, and the other should be one full size smaller. In an emergency where the stoma is swollen, a smaller tube may be the only option for reinsertion.
• Obturator: A guide for inserting the tracheostomy tube. It must be kept with its corresponding tube and removed immediately after insertion, as the patient cannot breathe with it in place.
• Tracheal Dilators: These are used to keep the stoma open in case the tube is accidentally removed and difficult to re-insert.
• Manual Resuscitation Bag (Ambu Bag): This is essential for providing manual ventilation. It should be the correct size for the patient and equipped with a tracheostomy adapter.
• Blunt-ended Scissors: Used to quickly cut and remove tracheostomy ties or dressings in an emergency.
• 10ml Syringe: Necessary for deflating the cuff on a cuffed tracheostomy tube before removal or during a tube change.
• Water-Soluble Lubricant: Used sparingly to aid in the insertion of a new tracheostomy tube. Never use petroleum-based jellies, as they can damage the tube or the airway.
• Emergency Contact List: A clearly printed and visible list of emergency numbers for family, doctors, and respiratory therapists.

Daily Care and Suctioning Supplies

Routine care is crucial for preventing infection and maintaining a clear airway. A well-stocked supply of daily care items will make this process smoother and more hygienic.

Suctioning Equipment

• Suction Machine: This can be a wall-mounted unit or a portable battery-powered device, the latter being essential for any patient who leaves the bedside. The machine must always be charged and in good working order.
• Suction Catheters: Keep a variety of sizes to ensure the right fit. It is vital to use the correct size to prevent injury to the trachea.
• Sterile Water and Normal Saline: Used to rinse the suction tubing between uses and to instill saline drops into the tracheostomy tube if secretions are thick.
• Suction Connecting Tubing and Canister: Ensures a clear path for secretions to be removed and collected.

Stoma and Inner Cannula Care

• Tracheostomy Care Kit: Pre-packaged kits offer sterile, convenient access to many necessary supplies like gauze, cotton-tipped applicators, and cleaning brushes.
• Sterile Gauze Dressings: Used to dress the stoma site and absorb drainage. Fenestrated (pre-cut) dressings are often preferred.
• Tracheostomy Tube Holders/Ties: Secures the tracheostomy tube in place. Options include cotton twill ties or adjustable velcro straps.
• Disposable Gloves: Essential for maintaining a sterile and hygienic environment during all care procedures.
• Tracheostomy Tube Brushes/Pipe Cleaners: Required for cleaning reusable inner cannulas.

Humidification and Airway Management

Without a functioning upper airway, patients with a tracheostomy lose the natural warming and humidifying function of the nose and mouth. Providing external humidification is therefore essential to prevent mucous plugs and respiratory distress.

Humidification Methods

• Heat Moisture Exchanger (HME): Also known as an artificial nose, this small filter fits onto the end of the tracheostomy tube and helps retain warmth and moisture. HMEs are ideal for ambulatory patients.
• Nebulizer Machine: Used to deliver humidified air or medicated treatments directly to the airway. A tracheostomy mask or adapter is used for this.
• Sterile Water Ampules: Can be used to thin secretions and keep the airway moist.

Comparison of Tracheostomy Tube Types

Feature	Cuffed Tube	Cuffless Tube	Fenestrated Tube
Primary Use	Patients requiring mechanical ventilation or at high risk of aspiration.	Ambulatory patients, speaking, or those ready for decannulation.	Allows patients to speak and cough through the upper airway while having a trach tube.
Mechanism	An inflatable balloon (cuff) creates a seal against the tracheal wall.	No cuff, allowing air to pass around the tube into the upper airway.	Features a hole (fenestration) in the outer cannula to permit airflow.
Advantages	Prevents aspiration, ensures controlled ventilation delivery.	More comfortable, allows for speech and easier swallowing.	Enables speech and upper airway breathing with tube in place.
Disadvantages	Can cause tracheal irritation or damage if overinflated, and complicates speech.	Does not protect against aspiration.	Risk of granulation tissue forming in the fenestration.

The Bedside Environment: More Than Just Equipment

Beyond the specific tools, the patient's immediate environment must be conducive to safe and efficient care. The layout should be simple and organized.

Ensuring a Safe Bedside Area

• Clear Pathways: Keep the area around the bed free of clutter to allow caregivers easy access during routine care or emergencies.
• Proper Lighting: Adequate lighting is necessary for visibility during procedures like suctioning or tube changes.
• Waste Disposal: Have a designated, easily accessible container for medical waste.
• Patient Positioning: Ensure the bed can be adjusted to an optimal position for airway management, typically with the head slightly elevated.
• Patient Monitoring: For some patients, a pulse oximeter may be needed to continuously monitor blood oxygen saturation levels. For others, an intercom or video monitor might be necessary, particularly for children or non-verbal adults.

Final Recommendations for Preparedness

Successful tracheostomy care relies heavily on preparedness and education. Caregivers, both professional and familial, must be thoroughly trained on the use of all bedside equipment. Regular review of the emergency kit contents and expiration dates is crucial. It is also important to remember that all care should follow the specific instructions of the patient's healthcare provider.

For additional guidance, the American Thoracic Society offers valuable resources for patients and caregivers living with tracheostomies. Consistent communication with the medical team and a proactive approach to stocking supplies will lead to better outcomes and greater peace of mind for everyone involved in the patient's care.

Conclusion: Proactive Care for a Smoother Recovery

The answer to what equipment is needed at the bedside for a patient with a tracheostomy is extensive, covering everything from life-saving emergency tools to the mundane necessities of daily hygiene. By organizing these items logically and ensuring all caregivers are proficient in their use, the patient's safety is maximized. Proper preparation not only facilitates routine care but also provides confidence in handling unexpected complications, ultimately leading to a more secure and stable environment for the patient.

Frequently Asked Questions

What is the most crucial item to have in a tracheostomy emergency kit?

The most crucial items are a spare tracheostomy tube of the same size and one a size smaller, along with a manual resuscitation bag. These are essential for managing an emergency tube displacement.

Why do I need two sizes of spare tracheostomy tubes at the bedside?

You need a spare tube of the same size for a standard change, but a smaller one is necessary in an emergency. If the stoma has started to close or swell, a smaller tube might be the only one that can be successfully inserted.

How often should I check the emergency tracheostomy equipment?

All emergency tracheostomy equipment should be checked at least once per shift in a hospital setting, or weekly in a home care setting. Regularly check expiration dates and functionality of all items, especially the suction machine and resuscitation bag.

What is an HME and why is it important for a tracheostomy patient?

An HME (Heat Moisture Exchanger) is a device that attaches to the tracheostomy tube. It captures and returns moisture and warmth from the patient's exhaled breath, compensating for the natural humidification lost by bypassing the nose and mouth. This prevents secretions from becoming thick and difficult to clear.

Can I use petroleum jelly for lubricating the tracheostomy tube?

No, you should never use petroleum-based products like Vaseline. The oil base can damage the plastic of the tracheostomy tube and introduce harmful substances into the airway. Always use a water-soluble lubricant.

What kind of suction machine is best for home use?

For home use, a portable, battery-operated suction machine is highly recommended. It offers the flexibility to move around and is essential to have in case of a power outage, providing continuous access to suctioning capability.

Is it important to keep the suction equipment clean?

Yes, maintaining the cleanliness and sterility of all suction equipment is extremely important. Proper cleaning prevents the introduction of bacteria into the airway, reducing the risk of respiratory infections. Follow the manufacturer’s and healthcare provider's guidelines for cleaning and sterilization.