G.J. asks, "When patients with a tracheostomy are discharged home, what do they need to know to take care of themselves?"
Answer: Patients and families who are being discharged with a new tracheostomy need a great deal of teaching in order to become comfortable with their care. Ideally, this teaching takes place over a period of time, during several sessions and should begin as soon as possible before discharge. Teaching should include guidelines for infection control such as handwashing and proper handling of the tracheostomy and equipment. Patients should be given a list of supplies and instructed to ensure that all supplies have been received in the home before they leave the hospital.
Patients and family members should be taught about airway anatomy and parts of the tracheostomy tube, how they fit together. The most difficult thing for patients and family members to master is suctioning. They realize that suctioning creates discomfort and they are reluctant to cause discomfort for their loved one. However, effective suctioning is an essential skill.
They must also be taught how to clean the stoma and the inner cannula, and how to change the trach ties. When the tube is cuffed, they must also learn how to maintain effective cuff pressure. The tracheostomy tube must be changed at regular intervals (usually every 1-2 months), so they must learn how to change the entire tube. In addition, patients and family members must learn the early signs of infection so that they can report symptoms to their health-care provider.
Emergency management must begin in the home, so patient and family members should know what to do in the event of an obstructed tube and a dislodged tube, which are the most common emergencies.
Upon discharge, family members should place a call to the local fire department to provide information for emergency personnel so that they can be better prepared if dispatched to the home.
Patients and family members should know where emergency equipment is located, including the obturator, extra tracheostomy tubes, and manual resuscitation bag.
It is also important that patients are followed closely by a medical professional to regularly review their plan of care and ensure that needs are met.
More detailed information about tracheostomy care is presented in Chapter 7: Care of the Tracheostomy Patient and Chapter 12: Rehabilitation and Recovery. Emergency management is presented in Chapter 10: Complications and Emergency Procedures.
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