Tracheostomy Tube Change

Excerpt

Tracheostomy is a medical procedure that involves creating an artificial passage connecting the cervical trachea to the external environment, circumventing the larynx and upper aerodigestive tract. The term "tracheostomy" encompasses the procedure and the resulting tract between the trachea and the skin. The origins of tracheostomies can be traced back to ancient Egypt and were later studied in ancient Greece and Rome; however, the first documented life-saving tracheostomy was performed by Brassavola in Italy in 1546 on a patient with a peritonsillar abscess.

Severino popularized the procedure in the early seventeenth century, recognizing its efficacy during the 1610 diphtheria epidemic. In the early twentieth century, Chevalier Jackson played a crucial role in further developing and standardizing the technique, addressing numerous challenges and controversies associated with the procedure. However, as the twentieth century progressed, it became evident that oral or nasal intubation offered a safer and quicker alternative to tracheostomy, with lower complication rates. Consequently, contemporary tracheostomy necessitates careful consideration of indications, contraindications, risks, benefits, and standardized post-procedural care.

In the United States alone, over 83,000 tracheostomies were performed in 1999, marking a substantial increase between 1993 and 2012. In England, the National Tracheostomy Safety Project estimates indicate that approximately 15,000 percutaneous tracheostomies are conducted annually in intensive care units, with an additional 5000 surgical tracheostomies in the operating room.

Given the escalating number of patients undergoing tracheostomy, ensuring safe care demands proficiency in cleaning, suctioning, weaning, decannulation, and managing tracheostomy-related emergencies. Routine tracheostomy tube changes are integral to ongoing care, but complications may arise more frequently without the support of experienced personnel, proper education, and a robust interprofessional tracheostomy care team. This article provides a basic understanding of the tracheostomy procedure, its relevant anatomy, and the principles behind tracheostomy care, primarily focusing on the safe exchange of the tracheostomy tube.