Caring for the patient with a tracheostomy
About this Best Practice Statement
This statement is designed primarily for the non-specialist
practitioner, as an introductory statement and as a guide to best
practice and what support should be available locally. It is not
designed as a ¿how to¿ document, but where professional consensus
exists on particular procedures, this is recorded in the
statement.
The statement will support local policies and procedures. It is
the hope of the Practice Development Unit that, in time, the best
practice statements will stimulate research and the development of
a more formal evidence base; the statements are targeted at areas
of clinical practice where the formal evidence base is still in the
process of being developed and where there is a variation in
practice across Scotland.
This statement was first published in 2003, and was then revised
and republished in March 2007.
About Tracheostomy
A tracheostomy is an opening in the front of the trachea that
can be temporary or permanent. Temporary ones usually have a
tracheostomy tube in place to keep them open. Indications for the
formation of a tracheostomy will include protection from aspiration
in cases of swallowing impairment, to facilitate breathing and
weaning from artificial ventilation and to facilitate clearance of
secretions. Examples of patients who may have a tracheostomy are
those with neuromuscular disorders who have impaired swallowing and
coughing, those who have a poor cough or gag reflex after a head
injury or a protracted critical illness and patients who have had
their larynx removed surgically. As with the original, this revised
statement does not refer to care of patients with a
laryngectomy.
The different nature of the situations in which a tracheostomy
could be employed means that it is difficult to track the
epidemiology of this procedure. Due to the increasing
sophistication of medical technology and higher survival rates from
diseases such as motor neurone disease, the incidence of
tracheostomy in general wards and in the community is increasing.
In Scotland, the volume of tracheostomy operations over the last
decade has increased (Appendix 1). In 2002, the Ear, Nose and
Throat (ENT) Nursing network from the Nursing and Midwifery
Practice Development Unit, which subsequently merged with other
organisations to become NHS QIS, identified this topic as one where
guidance and support in the form of professional consensus would
help promote consistent practice across Scotland.
Published Date: 16 March 2011
