|VIEW THE MOBILE VERSION of www.homemedicine.ca|| Informational|
Medical ArticlesNecessity Of Ventilation Means Of Heating The Sick-room Relative Merits Of Open Fires Stoves And Furnaces
Next to its intrinsic value, our method gives the patient the...
Unsuccessful Bronchoscopy For Foreign Bodies
The limitations of bronchoscopic removal of foreign bodies ar...
The Surgical Form Of The Male And Female Axillae Compared
Certain characteristic features mark those differences which ...
Ulcers Case Xxviii
Mrs. U. aged 60, has been subject to ulcerated legs for sever...
The Habit Of Illness
IT is surprising how many invalids there are who have...
Alkalis (eg Ammonia Soda Or Potash)
Give dilute vinegar, followed by white of egg. ...
Skin Care Of
Among the vast majority of people air and water far too seldom...
Chloroform Or Ether (inhaled)
Fresh air. Pull tongue forward, and begin artificial respirati...
Ablutions And Rubbing With Iced Water Or Snow
In a few very obstinate cases, when no rash would appear afte...
WHEN we are tolerant as a matter of course, the nervous syste...
Neutralise by chalk or lime water, but not by soda or any alka...
Removal Of Open Safety Pins From The Trachea And Bronchi
Removal of a closed safety pin presents no difficulty if it i...
Decannulation in neoplastic cases depends upon the nature of...
Technic Of Specular Esophagoscopy
Recumbent patient. Boyce position. The larynx is to be expos...
Sitting (or Sitz) Bath
This bath, in whatever form administered, is essentially a sit...
Sudden Invasion Of The Nervous Centres
Of the different forms of scarlatina maligna the most dangero...
Site Of Lodgement
Almost all foreign bodies are arrested in the cervical esoph...
Natural Polarization Of Man's Physical Organism
The electro-vital fluid, in the animal economy, is subject to...
See Towels, Cold Wet. ...
See Headache. ...
Resume Of After-care Of A Tracheotomic Case
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
1. Always bear in mind that tracheotomy is not an ultimate object.
The ultimate object is to pipe air down into the lungs. Tracheotomy is
only a means to that end.
2. Sterile tray beside bed should contain duplicate (exact)
tracheotomy tube, Trousseau dilator, hemostat, thumb forceps, silver
probe, scissors, scalpel, probe-pointed curved bistoury. Sterile
3. Special nursing necessary for safety.
5. Sponge away secretions before they are drawn in.
6. Cover wound with wide large gauze square slit so it fits around
cannula under the tape holder. Pull off ravelings. Keep wet with
1 : 10,000 Bichloride solution.
7. Change dressing every hour or oftener.
8. Abundance of fresh air, temperature preferably about 70 degrees.
9. Nurse should remove inner cannula as often as needed and clean
it with pipe cleaner before boiling.
10. Outer cannula should be changed every day by the surgeon or
long-experienced tracheotomy nurse. A pilot should be used and care
should be taken not to injure the cut ends of the tracheal cartilage.
11. A sterile, bent probe may be inserted downward in the trachea
with both cannulae out to excite cough if necessary to expel
secretions. An aspirating tube should be used, when necessary.
12. A patient with a properly fitted cannula free of secretions
breathes noiselessly. Any sound demands immediate attention.
13. If the respiratory rate increase it is much more likely to be
due to obstruction in, malposition of, or shortness of the cannula
than to lung complications.
14. Be sure that:
(a) The cannula is clear and clean.
(b) The cannula is long enough to reach well down into the
trachea. A cannula that was long enough when the operation was done
may be too short after the cervical tissues swell.
(c) The distal end of the cannula actually is deeply in the
trachea. The only way to be sure is, when inserting the cannula, to
spread the wound and the tracheal incision with a Trousseau dilator,
then see the interior of the tracheal lumen and see the cannula
15. If after attending to the above mentioned details there are
still signs of obstructive dyspnea, a bronchoscopy should be done for
finding and removal of the obstruction in the trachea or main bronchi.
16. If all the pipes, natural and instrumental, are clear there
can be no such thing as obstructive dyspnea.
17. Pneumonia and pulmonary edema may exist before tracheotomy, but
they are rare sequelae.
18. Decannulation, in cases of tracheotomy done for temporary
conditions should not be attempted until the patient has slept at
least 3 nights with his cannula tightly corked. A properly fitted
cannula (i.e. one not larger than half the area of cross section of
the trachea) permits the by-passage of plenty of air. A partial cork
should be worn for a few days first for testing and weaning a child
away from the easier breathing through the neck. In cases of chronic
laryngeal stenosis a prolonged test is necessary before attempting
19. A tracheotomic case may be aphonic, hence unable to call for
20. The foregoing rules apply to the post-operative periods. After
the wound has healed and a fistula is established, the patient, if not
a child, may learn to care for his own cannula.
 21. Do not give cough-sedatives or narcotics. The cough reflex
is the watch dog of the lungs.
Next: Notes On Nursing Tracheotomized Patients
Previous: Resume Of Emergency Tracheotomy